Alessia Cerutti

University of Padova, Padua, Veneto, Italy

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Publications (19)51.19 Total impact

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    ABSTRACT: Conflicting data were reported about normalization of sizes of right chambers, systolic and diastolic function and prevalence of arrhythmias after ostium secundum atrial septal defect closure. We sought to compare surgical and percutaneous approaches in terms of arrhythmias, right chamber volumes, and function at long-term follow-up. In all, 107 patients were enrolled, all corrected at pediatric age. Forty-four of them were treated surgically with a right thoracotomy approach and 63 were treated percutaneously. All patients underwent a standard echocardiogram and electrocardiographic Holter examinations. No difference was detected between the two groups regarding right atrial or ventricular volumes. The global right ventricular function assessed by fractional area change was similar between the two groups. However, the longitudinal function and the diastolic function were significantly impaired in the surgical group (tricuspid annulus peak systolic excursion 23.7 ± 4.5 mm versus 18.7 ± 3.5 mm, p < 0.001; S' wave 13.7 ± 3.1 cm/s versus 9.8 ± 2.4 cm/s, p < 0.001; E/E' 4.7 ± 1.7 versus 7.1 ± 2.9, p < 0.001). There was a low incidence of supraventricular couples or runs, but slightly higher in the surgical group (6.8% versus 1.6%), although not statistically significant. No echocardiographic variable related to ventricular or supraventricular arrhythmic events. Either surgical or percutaneous closure of atrial septal defect have a similar efficacy on the volume normalization of the right chamber. Modern surgical techniques have a limited impact on the systolic and diastolic function as well as on the arrhythmic risk; however, the right ventricular longitudinal and diastolic function seems to be better preserved in the percutaneous group. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · The Annals of thoracic surgery
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    ABSTRACT: Functional geometry of left ventricle (FGLV) refers to the dynamical change in the ventricular shape during contraction and relaxation. It has been shown that FGLV significantly contributes to the regulation of contractility and cardiac pump function in health and disease. The aim of our work is to evaluate the FGLV in patients with various myocardial diseases. A control group of healthy people (n=22) was compared to the study groups of patients with ischemic heart disease (IHD, n=52) with preserved ejection fraction (EF); patients with dilated cardiomyopathy (DCM, n=15) before and after cardiac resynchronization therapy (CRT) and patients with paroxysmal atrial fibrillation (AF, n=10) before pacemaker implantation and after two periods of 3 months pacing in either of stimulation regimes with motion sensor or impedance sensor. In the latter group echocardiography was performed in the absence of AF attack. Based on 2D-echocardiography the following FGLV parameters were evaluated: a regional heterogeneity index (RHI);a systolic asynchrony index (SAI);a Gibson sphericity index (GSI); an apical conicity index (ACI);a Fourier shape-power index (FSPI). Patterns of the spatial and temporal heterogeneity of LV regional systolic function and FGLV indexes were characterized in control group and in patients. Although the average EF was not significantly lower in IHD patients as compared to the control group, a characteristic decrease in the apical regional function in the IHD patients was found. Both RHI and SAI increased significantly (RHI: 26±2% vs 15±2%; SAI: 18± 2% vs 13±2%, sensitivity of 34%; specificity of 99%), and a strong negative correlation between RHI and EF was shown. FSPI in IHD patients was statistically higher (indicating LV shape more far from spherical) throughout the contractile cycle. In DCM patients before operation, the FGLV characteristics dramatically differed from the control. In most patients responded to CRT by increased EF, normal FGLV characteristics restored in 5 days after operation. Unexpectedly, AF patients also demonstrated significantly disturbed FGLV as compared to control. Pacing changed FGLV patters in these patients differently depending on the stimulation regime. The spatio-temporal heterogeneity of LV regional wall motion is one of the characteristic features of normal cardiac pump function. FGLV changes in pathology. FGLV abnormalities are early predictors of LV pump function disturbances. FGLV recovery is accompanied with an increase in LV pump function. Therefore, FGLV parameters have to be evaluated in standard echocardiography.
    No preview · Conference Paper · Dec 2014
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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.
    No preview · Article · Dec 2014 · Brain & development

  • No preview · Conference Paper · Oct 2013
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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 20kg. © 2013 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
    No preview · Article · Oct 2013 · Artificial Organs
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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.
    No preview · Article · Mar 2013 · Cardiology in the Young
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    ABSTRACT: While mainly based on the use of fluorinated steroids, there is no standard management of anti-Ro/La-related congenital heart block (CHB). This is a report concerning two consecutive cases of anti-Ro/La-related second-degree block treated with betamethasone (4 mg/day), weekly plasmapheresis, and intravenous immunoglobulins (IVIGs; 1 g/kg) administered every 15 days, a therapy that was begun shortly after CHB was detected and continued until delivery. The newborns were also treated with IVIG (1 g/kg) soon after birth and continued fortnightly until the anti-Ro/La antibody levels became undetectable. In both cases second-degree AV block reverted to a stable sinus rhythm with a first-degree atrioventricular (AV) block. Moreover, there was no recurrence of CHB when therapy was suspended, as confirmed by a 29 month and an eight month follow-up, respectively.
    No preview · Article · Dec 2011 · Lupus
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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.
    No preview · Article · Oct 2011 · The Annals of thoracic surgery
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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.
    No preview · Article · Apr 2011 · Pediatric Cardiology
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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.
    No preview · Article · Nov 2010 · The Annals of thoracic surgery
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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.
    Full-text · Article · Sep 2010 · Journal of Inherited Metabolic Disease
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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.
    No preview · Article · Aug 2010 · The Annals of thoracic surgery
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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.
    No preview · Article · Sep 2008 · Journal of Cardiovascular Medicine
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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).
    Full-text · Article · Sep 2007 · European Journal of Cardio-Thoracic Surgery
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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.
    No preview · Article · Feb 2007 · Journal of Cardiovascular Medicine

  • No preview · Article · Mar 2005 · The Annals of thoracic surgery
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    Preview · Article · Dec 2003 · European Heart Journal – Cardiovascular Imaging
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    ABSTRACT: This study was aimed at investigating whether a circadian rhythm of peripheral resistance exists in patients with orthotopic cardiac transplantation (OCT) and whether it parallels that of blood pressure (BP). BP and leg flow and resistance (plethysmography) were monitored for 24 hours in 13 denervated OCT recipients and 13 control patients with native heart, matched for casual blood pressure. On the basis of BP trend, control patients showed a BP reduction during sleep, whereas OCT recipients did not. Leg resistance was significantly lower and leg flow significantly higher during sleep than during waking in all patients, and the extent of the nocturnal decrease was similar in the two categories. The decrease in leg resistance in patients confined to bed for 24 hours is caused by peripheral mechanisms and does not depend on the autonomic control of the heart. The nocturnal decline in BP depends, on the contrary, on cardiac control and is lost in patients with denervated heart.
    No preview · Article · Jan 2001 · American Heart Journal

  • No preview · Article · May 2000 · Pediatric Cardiology

Publication Stats

76 Citations
51.19 Total Impact Points


  • 2001-2013
    • University of Padova
      • • Department of Cardiac, Thoracic and Vascular Sciences
      • • Department of Pediatrics
      • • Department of Medicine DIMED
      Padua, Veneto, Italy
  • 2010
    • University-Hospital of Padova
      Padua, Veneto, Italy