[show abstract][hide abstract] ABSTRACT: We describe the cases of 2 infants aged 6 and 2 1/2 months, respectively, affected by mitral valve dysplasia that caused severe valvular insufficiency and heart failure in which a surgical correction was indicated because of critical general conditions. In both patients the anatomic characteristics of the valves were not suitable for repair, and an implant of a mechanical prosthesis was excluded because of the very young age of the infants and the impossibility of maintaining an adequate anticoagulant therapy. Therefore a Ross-Kabbani intervention was performed with an implant of a pulmonary autograft (in the mitral position) and an insertion of a pulmonary homograft. The postoperative course was free of major complications and good function of the autograft was present at short-term follow-up in both cases.
The Annals of thoracic surgery 07/2005; 79(6):2150-1. · 3.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: Electrophysiological abnormalities underlying the increased arrhythmogenicity of left ventricular hypertrophy (LVH) are still under investigation. The aim of this study was to assess non-invasively the electrophysiologic alterations in two different types of LVH, METHODS: Multiparametric non-invasive ECG analysis (R-R interval, QRS and QT intervals, QT dispersion, T-wave complexity, activation-recovery interval [ARI] dispersion, standard deviation of RR intervals [SDNN], filtered QRS duration [fQRS], root-mean-square voltage of the terminal 40 ms of the fQRS [RMS40] and low amplitude signal duration (< 40 microV) in the terminal portion of the fQRS [LAS]) was performed in 57 patients with hypertensive LVH and hypertrophic cardiomyopathy (HCM), and in 105 healthy subjects.
The R-R interval and SDNN were similar in hypertrophic patients and controls. QRS and QT intervals were longer in hypertrophic patients without any differences between hypertensive LVH and HCM. QT dispersion, T-wave complexity and fQRS were greater in hypertrophic patients; QT dispersion was the greatest in HCM. ARI dispersion was lesser in hypertrophic patients without any differences between subgroups of LVH. fQRS showed a trend toward higher values in hypertensive patients. LAS at 25 Hz had a trend toward lower values in HCM patients, while LAS at 40 Hz and RMS40 showed no difference between controls and hypertrophic patients. Left ventricular mass index was not correlated with any of the above-mentioned parameters.
The QT interval and dispersion did not identify the type of hypertrophy. Similarly, ARI dispersion which explores local variations of repolarization duration, and T-wave complexity could not distinguish patients with hypertensive LVH from those with HCM indicating that multiparametric ECG data are affected more by the presence of LVH, than by its type.
Italian heart journal: official journal of the Italian Federation of Cardiology 04/2005; 6(4):304-10.
[show abstract][hide abstract] ABSTRACT: Aortic valve replacement (AVR) in patients with a small annulus is controversial. Small-sized prostheses cause a residual obstruction to the left ventricular (LV) outflow and incomplete regression of LV hypertrophy, eventually affecting long-term survival (1-3). Root- enlarging techniques make possible the use of a larger prosthesis, though the procedure is demanding and is associated with a higher operative risk (4). In this study, the clinical and hemodynamic performance of 19 mm Sorin Bicarbon (SB) bileaflet valves (Sorin Biomedica, Saluggia, Vercelli, Italy) after AVR was ret- rospectively evaluated.
The Journal of heart valve disease 06/2004; 13 Suppl 1:S35-6. · 1.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report the case of a 41-year-old woman with severe mitral regurgitation due to infective endocarditis caused by a rare zoonotic microorganism (Capnocytophaga canimorsus). She had had a rheumatic mitral endocarditis successfully treated with antibiotics when she was 13 years old. She arrived to our attention for a fever of unknown origin. She had been bitten by her dog and medicated the wound herself. About 2 weeks later she developed a fever with values up to 39.5 degrees C. Blood cultures were initially negative but in view of her particular history (dog bite), the samples were sent to a specialized center where a Capnocytophaga canimorsus (a commensal bacterium contained in the saliva of dogs and cats) infection sensitive to ceftriaxone was detected. The antibiotic therapy was consequently modified and the patient's fever resolved. At echocardiography a mild mitral stenosis with severe regurgitation (3-4+/4+) was detected. We planned surgical mitral repair but the operative findings clearly showed the need for mitral replacement and a 29 mm size bileaflet mechanical prosthesis was implanted. The postoperative course was regular and the patient was discharged on the fifth day. We highlight the importance of a careful history and correct work-up for the diagnosis and treatment of false negative blood culture endocarditis.
Italian heart journal: official journal of the Italian Federation of Cardiology 11/2003; 4(10):725-7.
[show abstract][hide abstract] ABSTRACT: The optimal management of moderate (grade 2-3+) ischemic mitral regurgitation (MR) at the time of coronary artery bypass grafting (CABG) remains the subject of controversy. The study aim was to determine whether mitral repair associated with CABG is preferable to CABG alone in patients with moderate ischemic MR, in terms of intermediate outcome.
Among 60 patients with moderate ischemic MR, 30 who underwent CABG plus mitral repair were compared with 30 others who underwent CABG alone. All patients underwent follow up echocardiographic and clinical examinations between 12 and 36 months after surgery. The decision to repair the valve during surgery was totally at the surgeons' discretion.
Preoperatively, both groups were substantially homogeneous. Patients who had CABG plus mitral repair had a lower NYHA functional class at intermediate follow up, and fewer signs and symptoms of heart failure. On multivariate analysis, mitral repair proved to be a protective factor for the development of heart failure. The preoperative size of the mitral annulus was seen to be a risk factor for subsequent heart failure events. At intermediate follow up, echocardiographic parameters were significantly better in the mitral repair group (left ventricular volume smaller, ejection fraction and pulmonary artery pressure improved).
The results of this case-control study showed that, in a homogeneous series of patients with moderate ischemic MR, repair of the mitral valve at the time of CABG leads to a better clinical status due to an improved hemodynamic profile.
The Journal of heart valve disease 06/2003; 12(3):272-9. · 1.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: Sudden cardiac death represents a major public health problem, but in the general population the identification of those subjects at very high risk remains poor. Simultaneous multiparametric ECG analysis can improve the identification of high-risk patients.
Five-min ECG recordings at a 5 MHz sampling rate (extended length-XL-ECG, Mortara Instruments, Milwaukee, WI, USA) were acquired in 105 healthy subjects (age range 21 to 80 years), equally distributed for age decades and sex, and three additional recordings, 30 min apart, were repeated in 30 subjects on the second day. The following parameters were recorded and analyzed: the RR interval, QRS duration, QT interval corrected according to the Bazett and Fridericia formulae, QT dispersion, T wave complexity, activation-recovery interval dispersion, standard deviation of the RR intervals, filtered QRS duration, the square root of the mean voltage of the last 40 ms of the filtered QRS, and the length of time that the terminal vector magnitude complex remains < 40 microV.
QRS duration, activation-recovery interval dispersion, and filtered QRS differed in the two sexes. The standard deviation of the RR intervals, T wave complexity and QT dispersion were significantly correlated with age. The reproducibility was good for each parameter.
The XL-ECG allows the simultaneous calculation of eight adequately reproducible different parameters the values of which are in agreement with those of the literature. Thus, XL-ECG is a reliable time- and cost-saving tool.
Italian heart journal: official journal of the Italian Federation of Cardiology 05/2002; 3(5):308-17.