Publications (15)27.26 Total impact
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Article: Anterior mitral valve aneurysm perforation in a patient with preexisting aortic regurgitation.
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ABSTRACT: We report the case of a 71-year-old man hospitalized for acute heart failure. Transthoracic and transesophageal echocardiography showed mitral valve aneurysm (MVA) rupture and severe mitral regurgitation. No vegetations but significant aortic regurgitation were also observed. MVA perforation is a rare life-threatening condition that typically occurs as a complication of endocarditis but may also be associated with other diseases, in particular connective tissue disorders. In the present case, the absence of such etiology suggests a possible role for of aortic regurgitation in MVA rupture secondary to a "jet lesion" mechanism.Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 12/2012; 78(4):210-1. -
Article: Tako-tsubo syndrome soon after caesarean delivery: two case reports.
International journal of cardiology 05/2012; · 7.08 Impact Factor -
Article: On-pump versus off-pump coronary artery bypass surgery in high-risk patients: operative results of a prospective randomized trial (on-off study).
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ABSTRACT: To analyze the risk reduction of cardiopulmonary bypass complications between on-pump and off-pump coronary artery bypass grafting in high-risk patients. This multicenter, prospective, randomized, parallel trial enrolled patients for elective or urgent isolated coronary artery bypass grafting with an additive European System for Cardiac Operative Risk Evaluation of 6 or more. The patients in cardiogenic shock were excluded. The composite primary end point included operative mortality, myocardial infarction, stroke, renal failure, reoperation for bleeding and adult respiratory distress syndrome within 30 days after surgery. The total sample size was 693 patients, according to a scheduled interim analysis at 400 patients enrolled (α-spending = 0.029, Pocock method). A total of 411 patients were included in the interim analysis. Randomization assigned 203 patients to on-pump and 208 patients to off-pump treatment. Of the 411 patients, 24 crossed over; thus, 195 patients were actually treated on-pump and 216 off-pump. According to the intention to treat analysis, the rate of the composite primary end point was significantly lower (unadjusted P = .009, adjusted P = .010) in the off-pump group (5.8% vs 13.3%). The risk of experiencing the primary end point was significantly greater for the on-pump group (unadjusted odds ratio, 2.51; 95% confidence interval, 1.23-5.10; P = .011; adjusted odds ratio, 3.07; 95% confidence interval, 1.32-7.14; P = .009). Off-pump coronary artery bypass grafting reduces early mortality and morbidity in high-risk patients.The Journal of thoracic and cardiovascular surgery 12/2011; 143(3):625-31. · 3.41 Impact Factor -
Article: Echocardiographic assessment of regional left ventricular wall motion abnormalities in patients with tako-tsubo cardiomyopathy: comparison with anterior myocardial infarction.
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ABSTRACT: The aim of this study was to assess the echocardiographic distribution of regional wall motion abnormalities (RWMA) in patients with tako-tsubo cardiomyopathy (TTC) compared with anterior ST-elevation myocardial infarction (ant-STEMI). Thirty-seven TTC and 37 ant-STEMI patients underwent standard echocardiographic examination at the time of hospital admission. RWMA and the involvement of the left ventricular territories supplied by each coronary artery according to the American Society of Echocardiography classification were reported. TTC patients showed a lower left ventricular ejection fraction (37.6 ± 5.1 vs. 40.9 ± 3.7%; P = 0.002) and a higher wall motion score index (WMSI; 1.98 ± 0.2 vs. 1.51 ± 0.14; P < 0.001) compared with ant-STEMI patients. No significant differences were observed between groups with regard to detection of RWMA in the territory supplied by the left anterior descending coronary artery (LAD) (37 vs. 37; P = 1). Conversely, in TTC patients, the territories supplied by the LAD/left circumflex coronary artery (LCX) (37 vs. 31; P = 0.011), LAD/right coronary artery (RCA) (34 vs. 13; P < 0.001), RCA (33 vs. 5; P < 0.001), and RCA/LCX (31 vs. 2; P < 0.001) were more frequently involved. A cut-off value of WMSI ≥1.75 (area under the curve 0.956) and for the number of territories with RWMA ≥4 (AUC = 0.928) predicted TTC with a sensitivity of 83 and 84% and a specificity of 100 and 97%, respectively. Echocardiography revealed a distinctive pattern of contractility in TTC patients, characterized by symmetrical RWMA extending equally into the territory of distribution of all coronary arteries.European Heart Journal – Cardiovascular Imaging 05/2011; 12(7):542-9. · 2.32 Impact Factor -
Article: Intramural aortic hematoma: no flap no warning?
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ABSTRACT: We report a case of type A intramural aortic hematoma (IMH) occurred in a 78 years old female. The clinical scenario (medical history of hypertension, severe substernal chest pain, early diastolic decrescendo murmur as for aortic insufficiency), the laboratory results (no significant troponin level), ECG and transthoracic echocardiography findings (no signs of myocardial ischemia) shifted the initial diagnostic suspicion from acute coronary syndrome to the acute aortic syndrome (AAS) and triggered further imaging tests. Computed tomography revealed an aneurismatic dilatation with thickening of the wall of the ascending aorta without intimal flap. No particular "warning message" for evidence of AAS was sent to the clinician on call. Subsequently, due to the persisting high clinical suspicion transesophageal echocardiography (TEE) was performed. TEE confirmed the aneurysm of the ascending aorta and highlighted an extended and marked aortic wall thickness, consisting with the diagnosis of type A IMH. Patient underwent urgent cardiac surgery that confirmed the diagnosis.Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 03/2011; 76(1):47-9. -
Article: Surgical treatment of impending paradoxical embolization associated with pulmonary embolism in a patient with heterozygosis of factor V Leiden.
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ABSTRACT: We report an unusual case of impending paradoxical embolization in a 69-year-old woman heterozygote carrier of factor V Leiden mutation. The patient presented to the emergency room with the clinical scenario of massive pulmonary embolism. Serial echocardiographic examinations revealed a large thrombus in the right atrium floating via a patent foramen ovale into the left atrium. Anticoagulation therapy was started. After 72 h, due to the unresolved thrombus, the patient underwent surgical treatment consisting of complete excision of the thrombus, closure of the foramen ovale, and pulmonary embolectomy. No in-hospital complications were noted. At 1-year follow-up, the patient is doing well on long-term anticoagulation treatment free of thromboembolic events.Journal of Cardiovascular Medicine 07/2010; · 1.51 Impact Factor -
Article: Myocardial revascularization by left ventricular assisted beating heart is associated with reduced systemic inflammatory response.
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ABSTRACT: The present study was designed to investigate whether use of left ventricular assisted technique (LVA) in beating-heart myocardial revascularization would exert less impact on patients' inflammatory response, as compared with minimal extracorporeal circulation (MECC). Seventy-three consecutive high-risk patients undergoing myocardial revascularization were randomly assigned either to LVA (group A) or to MECC (group B). Monocyte count and plasma concentration of C-reactive protein, inflammatory cytokines interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha, and polymorphonuclear elastase were measured at baseline and at various time points postoperatively. Preoperative clinical and demographic data did not differ between the two groups. The two groups also were similar with respect to mortality, number of grafts performed, duration of extracorporeal circulation, and need for inotropes. However, LVA was associated with significantly less inflammatory response postoperatively compared with MECC, as indicated by a significant difference in interleukin-6 (p = 0.002), C-reactive protein (p = 0.002), monocyte percentage (p = 0.006), tumor necrosis factor-alpha (p = 0.002), and polymorphonuclear elastase (p = 0.001). High-risk patients undergoing beating-heart myocardial revascularization with LVA show reduced inflammatory response compared with patients treated with the MECC.The Annals of thoracic surgery 02/2009; 87(1):46-52. · 3.74 Impact Factor -
Article: Giant left atrial myxoma: an unusual cause of acute pulmonary edema.
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ABSTRACT: We report a case of a huge left atrial myxoma with an unusual clinical presentation characterized by acute pulmonary edema. The possible pathophysiologic mechanism has been discussed.Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2008; 21(8):978.e1-3. · 2.98 Impact Factor -
Article: Valve surgery in octogenarians: in-hospital and long-term outcomes.
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ABSTRACT: Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. Three hundred seven consecutive patients 80 years and older (60% female; mean age 83+/-2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94). The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0+/-0.7 to 1.7+/-0.6; P<0.0001). Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients' preoperative clinical status and increased comorbidity than the type of surgery per se.The Canadian journal of cardiology 03/2007; 23(3):223-7. · 3.36 Impact Factor -
Chapter: Vascular Surgical Options
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ABSTRACT: In the last decade, the surgical therapy for acute type A aortic dissections (AAAD) has been modified by new techniques that have improved the outcome. Continuous efforts have led to safer, more rapid, and more durable operations using new technology and new knowledge concerning the pathophysiology of the disease and the surgical long-term results. Some of these procedures (like the use of glue or other adjuncts to reinforce the aortic stumps) are already established techniques. Others “in progress” (like different modes of cerebral protection, sites of arterial cannulation, aortic valve management, and the extended aortic arch replacement) are still debated. Finally, procedures like the combined treatment of ascending aortic replacement associated with a stent graft positioned in the aortic arch and other endovascular techniques (hybrid procedures) seem to be the vascular surgical options for the future. These procedures appear as adjuncts to conventional surgical interventions but need to be evaluated for indications, feasibility, and long-term results.12/2006: pages 333-346; -
Article: Aortic valve dysfunction and dilated ascending aorta. A complex and controversial association.
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ABSTRACT: Several pathogenetic mechanisms account for the association of the ascending aorta dilation with aortic valve dysfunction. Functional aortic insufficiency can derive from medial degeneration of the aortic wall and annuloaortic ectasia; leaflet structural disease can determine root dilation by increasing aortic wall stress in case of both regurgitation and stenosis; aortic valve disease and aortic aneurysm can however coexist due to two different intrinsic etiologies. In the attempt to best tailor the surgical correction of such conditions to the underlying causative mechanism, several technical options have already been developed including composite or separate aortic valve and root replacement, valve-sparing operations, and aortoplasty techniques. The criteria for surgical indication cannot leave the underlying pathogenesis out of consideration as well. The newly acquired knowledge in the basic research on this topic is expected to affect the approach to the individual patient in the future.Italian heart journal: official journal of the Italian Federation of Cardiology 10/2003; 4(9):589-95. -
Article: Surgical results of aortic valve replacement via partial upper sternotomy: comparison with median sternotomy.
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ABSTRACT: the theoretical advantages of mini-invasive cardiac surgery are shorter hospitalisation, better surgical results and costs reduction. In November 1997 we started a non-coronary mini-invasive surgery program using a partial upper median sternotomy. This study has been conceived to retrospectively compare two groups of patients who underwent isolate aortic valve replacement using the conventional and the mini-invasive technique. in Group A 100 patients (mean age 62+/-12 years; 58 male) underwent isolated aortic valve replacement through a partial upper median sternotomy. Group B was composed by the last 100 patients (mean age 63+/-8 years; 56 male) who underwent the same operation through a conventional median sternotomy. For both groups we recorded the ECC and ischaemic times, postoperative intubation time, total postoperative bleeding, intensive care unit length of stay and total hospitalisation time. Major and minor complications were reported. operating times, were significantly longer in Group A (p<0.001). Mechanical ventilation time, ICU and total hospital stay, and total postoperative bleeding showed no significant difference. Adjunctive statistical evidenced the absence of learning curve. Mortality and other complications failed to reveal any significant difference between the two groups. in our experience, partial upper median sternotomy does not increase surgical risks but failed to demonstrate clear advantages. Apart for an increase in operating times, the surgical results are similar to those of a conventional median sternotomy with only improvement in the aesthetical aspect. In our opinion, this supports the conviction that this approach can be proposed to selected patients, to obtain a better cosmethical result for the same given risk.Cardiovascular Surgery 08/2002; 10(4):333-8. -
Article: Transesophageal Echocardiographic Diagnosis of a Dehisced Carpentier Mitral Ring
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ABSTRACT: We describe an unusual case of gross dehiscence of a Carpentier mitral ring, not due to bacterial endocarditis, causing severe mitral valve insufficiency and cardiac failure. Diagnosis was made by transesophageal echocardiography (TEE). Mitral valve replacement was then performed.Echocardiography 10/2000; 17(8):731 - 732. · 1.24 Impact Factor -
Article: Successful treatment of leakage of serous fluid following construction of a polytetrafluorethylene central shunt
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ABSTRACT: A central polytetrafluorethylene shunt was constructed in a 13-year-old boy after previous placement of a Waterston-Cooley shunt. Because of excessive leakage of serous fluid from the prosthesis, the boy required a second operation when the shunt was wrapped with absorbable collagen hemostat (Novacol FibrillarTM). The leakage stopped suddenly and the boy was discharged home after one week. Follow-up at four months shows no pericardial effusion and good function of the shunt.Cardiology in the Young 12/1994; 5(01):94 - 95. · 0.76 Impact Factor -
Article: Metastatic melanoma: an unusual presentation.
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ABSTRACT: In this report we describe a case of a malignant cutaneous melanoma metastasizing to the pleural surface and peritoneal cavity 5 years after surgical resection of the primary lesion. Malignant cutaneous melanoma is a very aggressive cancer able to metastasize anywhere in the body. Pleural secondary lesions represent a rare event described only in a small number of patients and the association with peritoneal localizations may suggest an uncommon pattern of spread that we discuss.Tumori 97(1):130-2. · 0.86 Impact Factor
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2002
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Azienda Ospedaliera Universitaria OO.RR. S.Giovanni di Dio e Ruggi d'Aragona
Salerno, Campania, Italy
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