Gabriele Bronzetti

University of Bologna, Bolonia, Emilia-Romagna, Italy

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Publications (60)240.72 Total impact

  • Gabriele Bronzetti · Maurizio Brighenti · Marco Bonvicini
    [Show abstract] [Hide abstract] ABSTRACT: Syncope is common in pediatric population, carrying a significant health and psychological impact. The incidence of syncope in the pediatric age that requires medical intervention is estimated at 125 of 100,000 subjects (0.125%). An incidence peak occurs around the age of 15 years, with females having more than twice the incidence of males. A lower peak occurs in older infants and toddlers, most commonly referred to as “breath-holding spells.†In the pediatric age, the most common etiology is certainly neurally mediated syncope (61—80%), followed by neurological—neuropsychiatric loss of consciousness (LOC) (11—19%), and cardiac syncope (6—11.5%). The etiology remains undetermined in 15—20% of cases.
    No preview · Chapter · Jan 2015
  • Gabriele Bronzetti · Marco Bonvicini
    No preview · Article · Dec 2014 · Giornale italiano di cardiologia (2006)
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    [Show abstract] [Hide abstract] ABSTRACT: Infantile hemangiomas (IHs) are the most common benign tumors of infancy and usually they don't require specific therapy. In 10-20% of cases IHs are able to generate complication and medical/surgical intervention is needed. For many decades standard treatment consisted in oral or intralesional corticosteroids untill Lèautë-Labrëze and colleagues published the first report on the efficacy of propranolol for cutaneous infantile hemangiomas in 2008. IHs can be sometimes part of complex syndrome. Here we report the case of a patient with tetralogy of Fallot operated at 5 month of age who stopped propranolol treatment for hypoxic spells and unusually developed facial and subglottic IHs configuring the diagnosis of PHACES syndrome (posterior fossa brain malformations, hemangioma, arterial anomalies, cardiac defects and/or aortic coarctation, ocular anomalies and sternal defects). To our knowledge this is the first first report in the international literature of a delayed appearance of an infantile hemangioma involving the skin and the airways (PHACES syndrome). The pathophysiological explanation relies in the mechanism of action of propranolol which seems to act initially with vasoconstriction, down-regulating proangiogenetic factors and inducing endothelial cell apoptosis. Many decades since their introduction β-blockers are useful in a growing group of diseases. The pleiotropic effect of β-adrenoceptors antagonists is not yet deeply understood, residing in neurohormonal regulation systems and angiogenesis and proving to be an effective treatment from cardiovascular to oncological illness.
    Full-text · Article · Mar 2014 · Current Medicinal Chemistry
  • [Show abstract] [Hide abstract] ABSTRACT: Supraventricular tachycardias in children still remain a challenge not only for the pediatrician, but also for the adult cardiologist who is facing an infant in an emergency situation. This review examines the unique aspects of pediatric arrhythmias, with particular emphasis on acute treatment and pharmacological prophylaxis. All current treatment options are focused, from the "old drugs" to the "novel ablative techniques": the first are often able to defer the second to a more suitable age, with fewer adverse effects and higher success rates. A brief account on Wolff-Parkinson-White issues concludes the review.
    No preview · Article · Sep 2013 · Giornale italiano di cardiologia (2006)
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    [Show abstract] [Hide abstract] ABSTRACT: Supraventricular tachycardias in children still remain a challenge not only for the pediatrician, but also for the adult cardiologist who is facing an infant in an emergency situation. This review examines the unique aspects of pediatric arrhythmias, with particular emphasis on acute treatment and pharmacological prophylaxis. All current treatment options are focused, from the “old drugs” to the “novel ablative techniques”: the first are often able to defer the second to a more suitable age, with fewer adverse effects and higher success rates. A brief account on Wolff-Parkinson-White issues concludes the review. Key words. Antiarrhythmic drugs; Children; Supraventricular tachycardia; Wolff-Parkinson-White syndrome.
    Full-text · Article · Sep 2013 · Giornale italiano di cardiologia
  • No preview · Article · Nov 2012 · International journal of cardiology
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    Full-text · Article · Oct 2012 · The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
  • Gabriele Bronzetti · Fabio Vagnarelli · Claudio Rapezzi
    No preview · Article · Sep 2012 · Giornale italiano di cardiologia (2006)
  • [Show abstract] [Hide abstract] ABSTRACT: In medical literature, few cases of Rasmussen's aneurysm have been reported until now, and to the best of our knowledge, there has been no description of a case of Rasmussen's aneurysm in childhood. The child described in the case report had a restrictive cardiomyopathy, complicated by pulmonary hypertension, in association with miliary tuberculosis.
    No preview · Article · Jan 2012 · Congenital Heart Disease
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    [Show abstract] [Hide abstract] ABSTRACT: Currently there is no evidence to prefer an endocardial or epicardial approach for pacing in pediatric patients. This analysis was aimed at defining the complications of pacemaker implantation in a pediatric population with atrioventricular block according to a strategy of choosing an epicardial system for patients <10 kg and an endocardial system for patients >10 kg. This is a retrospective study performed on 27 patients, with and without congenital heart disease, implanted with a permanent pacemaker because of idiopathic or acquired atrioventricular block at our Pediatric Cardiology and Cardiac Surgery Unit of S. Orsola-Malpighi Hospital in Bologna (Italy) between 1981 and 2010. Patients were divided into two groups: 70% of the population (group A) was implanted with an epicardial system, 30% (group B) with an endocardial system. After a mean follow-up of 14 years (17 ± 8 years for group A, 7 ± 5 years for group B), the most frequent complications were lead failure (44%) and infection (18%). Both were more common in the epicardial system group: lead failure rate 53% in group A vs 25% in group B (p=0.0001); infection rate 26% in group A vs 0% in group B (p=0.0001); rate of system revision or implantation of a new electrode 42% in group A vs 12% in group B (p=0.0001). The present study demonstrates a high complication rate in patients undergoing an epicardial pacing system implantation. However, in patients <10 kg the epicardial system allows subclavian venous access protection for endocardial system implantation after somatic growth, avoiding high-risk procedures of system revision or lead extraction and subclavian vein occlusion in the long term.
    Full-text · Article · Nov 2011 · Giornale italiano di cardiologia (2006)
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    [Show abstract] [Hide abstract] ABSTRACT: Diastolic dysfunction of the right ventricle (RV) is common after repair of tetralogy of Fallot. While restrictive physiology in late diastole has been well known, dysfunction in early diastole has not been described. The present study sought to assess the prevalence and mechanism of early diastolic dysfunction of the RV defined as delayed onset of the tricuspid valve (TV) flow after TOF repair. The study population consisted of 31 children with repaired TOF (mean age ± SD, 12.3 ± 4.1 years) who underwent postoperative cardiovascular magnetic resonance (CMR). The CMR protocol included simultaneous phase-contrast velocity mapping of the atrioventricular valves, which enabled direct comparison of the timing and patterns of tricuspid (TV) and mitral (MV) valve flow. The TV flow was defined to have delayed onset when its onset was > 20 ms later than the onset of the MV flow. The TV and MV flow from 14 normal children was used for comparison. The CMR results were correlated with the findings on echocardiography and electrocardiography. Delayed onset of the TV flow was observed in 16/31 patients and in none of the controls. The mean delay time was 64.81 ± 27.07 ms (8.7 ± 3.2% of R-R interval). The delay time correlated with the differences in duration of the TV and MV flow (55.94 ± 32.88 ms) (r = 0.90, p < 0.001). Delayed onset was associated with prolongation of the RV ejection time in 9 and delayed onset and cessation of the pulmonary arterial flow in 4. Delayed onset was not associated with timing changes in the pulmonary artery in 3. The patients with delayed onset showed reduced RV ejection fraction (p = 0.01). However, the two groups did not show significant differences in TV E/A ratio, ventricular end-diastolic volumes, left ventricular ejection fraction, pulmonary regurgitant fraction, heart rate, PR interval and QRS duration. Early diastolic dysfunction with delayed onset of TV flow is common after TOF repair, and is associated with reduced RV ejection fraction. It is a further manifestation of interventricular dyssynchrony and represent an additional mechanism of ventricular diastolic dysfunction.
    Full-text · Article · Aug 2011 · Journal of Cardiovascular Magnetic Resonance
  • [Show abstract] [Hide abstract] ABSTRACT: During life ECG is always changing according to postnatal circulation adaptation, position of the heart in the chest, and body mass. Reference values and normal morphologies of P wave, PR interval, QRS complex, ST segment, T wave, and QTc interval are reported. Some clues to detect congenital and acquired heart diseases are also provided. Finally, a brief look at the most common diseases and arrhythmias in the neonatal and pediatric period is reported. When the pediatric ECG is too "young" for a cardiologist? When we need to stop doing the report? ... never! The baby is the father of the adult. The heart is made of signs: we have to decipher them.
    No preview · Article · Jun 2011 · Giornale italiano di cardiologia (2006)
  • Gabriele Bronzetti
    No preview · Article · Apr 2011 · Pacing and Clinical Electrophysiology
  • [Show abstract] [Hide abstract] ABSTRACT: Percutaneous aortic valvuloplasty is an effective means of treatment for congenital aortic valve stenosis. The aim of this study was to evaluate the immediate results of valvuloplasty, to analyze the medium to long-term outcome and to assess its efficacy in preventing or postponing a new percutaneous valvuloplasty or aortic valve surgery. We retrospectively analyzed the reports of 37 patients aged > 1 month (mean age 6.3 years) who underwent aortic valvuloplasty for severe aortic stenosis. Associated congenital cardiac defects were present in 16% of the patients. The average time of follow-up was 5.07 years. Particular attention was focused on occurrence and progression of aortic regurgitation. Hemodynamic gradient after aortic valvuloplasty decreased from 58.5 to 22.5 mmHg, with an average decrease of 61.5%. On echography, the maximum gradient decreased from 93.0 to 40.5 mmHg, with an average decrease of 56.5%; mean gradient decreased from 52.0 to 20.5 mmHg with an average decrease of 60.6%. At last follow-up the average maximum and mean gradient on echo were 50.0 and 27.0 mmHg. A reintervention was needed in 21.6% of cases: a second valvuloplasty in 8.1% and aortic surgery in 13.5%. The mortality rate was 2.7%. Survival after 14 years was 97.2%; freedom from aortic valve surgery was 85.5%, from a second valvuloplasty was 89.5%, and from any type of procedure was 76.1%. Percutaneous aortic valvuloplasty is a safe and effective treatment for congenital aortic stenosis in patients aged > 1 month. Aortic regurgitation is the main concern in the follow-up. Nonetheless, 14 years after valvuloplasty, over 75% of patients are free from any type of aortic valve reintervention.
    No preview · Article · Sep 2010 · Giornale italiano di cardiologia (2006)
  • Gabriele Bronzetti · Alessandro Corzani
    No preview · Article · Jul 2010 · Clinical Pediatrics
  • [Show abstract] [Hide abstract] ABSTRACT: Atrial fibrillation (AF) after transcatheter closure of patent foramen ovale (PFO) is not a rare complication. However little is known about the effect of atrial septal device implantation on the occurrence of this arrhythmia. The aim of this study was to evaluate the occurrence of AF in two groups of patients who underwent transcatheter PFO closure: those with a previous cryptogenic stroke and those with other index events respectively. Patient population included 276 patients with documented PFO who underwent percutaneous closure at our institution. Patients were grouped on the basis of two distinct clinical presentations: a) 246 patients with history of previous cryptogenic cerebrovascular ischemic event (CIE) or b) 30 patients with other different index events. AF after PFO closure was detected by 12-lead electrocardiography or by 24-h-Holter monitoring. During a mean follow-up of 17 months, new-onset AF was documented in 10 patients (4%), all included in the group with a previous cryptogenic CIE, at a mean of 1.6 months post-procedure. Comparing patients with and without AF, age (mean 56 years vs 46 years, p = 0.012) and left atrial size (4.4 cm vs 3.7 cm, p = 0.001) resulted to differ significantly. The type and size of occluder devices do not seem to impact the occurrence of AF after PFO closure. In patients presenting with cryptogenic stroke, especially in those with slightly enlarged left atria and age above 50–55 years, detection of a PFO should prompt an extended monitoring for excluding AF.
    No preview · Article · Jun 2009 · International journal of cardiology
  • [Show abstract] [Hide abstract] ABSTRACT: Atrial thrombosis is a relatively rare event in children. We report a case of a newborn with AFI who after restoration of sinus rhythm, developed atrial thrombus on a prominent Chiari network floating between the right and left atrium through the patent foramen ovale. The thrombus was resolved following treatment with heparin without events. Conclusion: Atrial stunning was proposed as a key mechanistic phenomenon because the thrombus occurred after the cardioversion of AFI to sinus rhythm. Heparin may be effective in the resolution of atrial thrombus within a few days.
    No preview · Article · Mar 2009 · Acta Paediatrica
  • [Show abstract] [Hide abstract] ABSTRACT: Amiodarone is an effective antiarrhythmic agent and represents the drug of choice in the treatment of severe arrhythmias, especially in the setting of ventricular dysfunction. Amiodarone has the potential for interaction with many cardiac and non-cardiac drugs. Nonetheless few incompatibilities have been reported. We report the incompatibility between amiodarone and heparin administrated in the same vein in a case of a one month old baby with atrial flutter. This topic needs more attention, due to the frequent co-administration of these two drugs in tachyarrhythmias with high thromboembolic risk.
    No preview · Article · Mar 2009 · International journal of cardiology
  • Gabriele Bronzetti
    No preview · Article · Mar 2009 · Pacing and Clinical Electrophysiology
  • [Show abstract] [Hide abstract] ABSTRACT: The long-term risk of atrial fibrillation and flutter (AFF) after trascatheter atrial septal defects (ASD) closure in adults is unknown. We studied 134 patients who have undergone transcatheter ASD closure at our institution at an age of > 18 years (mean age 39 +/- 16 years); Patients were followed-up for 4.8 +/- 2.7 years (range 0.8-9.6 years). We assessed the presence of AFF both before and after ASD closure using standard 12 lead ECGs or 24h ambulatory Holter monitors. 13 patients (10%) had documented AFF before the procedure (paroxysmal in 6, permanent in 7). Patients with AFF before the procedure were older (p < 0.0001), and had worse clinical condition (p = 0.0008). Patients without a history of AFF before the procedure and those who experienced paroxysmal AFF before the procedure had a very low annual risk (0%) of subsequent permanent AFF at long-term follow-up. Four patients with permanent AFF before the procedure (onset of < 12months) underwent electrical cardioversion immediately before ASD closure. Two of them (50%) are in sinus rhythm after 4.1 and 7.0 years, respectively. Transcatheter ASD closure performed in adults with no history of AFF or with a history of paroxysmal AFF before closure seems to protect from development of AFF in the long-term. In selected patients with permanent AFF at closure, device ASD closure together with arrhythmia cardioversion might be able to restore and maintain sinus rhythm in the long-term.
    No preview · Article · Apr 2008 · International journal of cardiology