IRCCS Centro Cardiologico Monzino

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IRCCS Centro Cardiologico Monzino

Italy
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Zanobini M.,IRCCS Centro Cardiologico Monzino
Journal of Cardiovascular Medicine | Year: 2017

BACKGROUND: Leaflet resection represents the reference standard for surgical treatment of mitral valve (MV) regurgitation. New approaches recently proposed place emphasis on respecting, rather than resecting, the leaflet tissue to avoid the drawbacks of the ‘resection’ approach. OBJECTIVES: The lateral dislocation of mid portion of mitral posterior leaflet (P2) technique for MV repair is a nonresectional technique in which the prolapsed P2 segment is sutured to normal P1 segment. Our study evaluates the effectiveness of this technique. PATIENTS AND METHODS: We performed the procedure on seven patients. Once ring annular sutures were placed, the prolapsed P2 segment was dislocated toward the normal P1 segment with a rotation of 90° and without any resection. If present, residual clefts between P2 and P3 segments were closed. Once the absence of residual mitral regurgitation is confirmed by saline pressure test, ring annuloplasty was completed. The valve was evaluated using transesophageal echocardiography in the operating room and by transthoracic echocardiography before discharge. RESULTS: At the last follow-up visit, transthoracic echocardiography revealed no mitral regurgitation and normal TRANSVALVULAR gradients. CONCLUSION: The lateral dislocation of P2 is an easily fine-tuned technique for isolated P2 prolapse, with the advantage of short aortic cross-clamp and cardiopulmonary bypass times. We think it might be very favorable in older and frail patients. Long-term follow-up is necessary to assess the durability of this technique. © 2017 Italian Federation of Cardiology. All rights reserved.


Merli G.,IRCCS Centro Cardiologico Monzino | Chiumello D.,University of Milan
Minerva Anestesiologica | Year: 2015

Maxillofacial trauma poses a challenge for the anesthesiologist because injuries can often compromise the patient's airways. Airway maintenance is the first step in the American College of Surgeons Advance Trauma Life Support (ATLS®) protocol. However, clinical dilemmas may arise about the best way to manage a potentially life-threatening injury. There are no recommendations about the best time to intubate, the warning signs for deciding to intubate, or which device should be used when difficulty is expected. In this context the ATLS® approach is important but not sufficient. It is also necessary to recognize and be able to manage specific problems in this scenario where clinical priorities may be conflicting, may suddenly change or may be hidden. This clinical review discusses the complexity of this scenario, providing an overview of the conditions at greatest risk for airway obstruction and the options for airway management, on the basis of the recent literature. Clinicians must recognize the milestones and pitfalls of this topic in order to adopt a systematic approach for airway management, to identify specific characteristics associated with it, and to establish the utility of different instruments for airway management. © 2015 EDIZIONI MINERVA MEDICA.


PubMed | University of Turin, Vita-Salute San Raffaele University, Policlinico S. Orsola Bologna, University Cattolica Rome and 8 more.
Type: Journal Article | Journal: Insights into imaging | Year: 2016

Cardiac magnetic resonance (CMR) is considered a primary tool for the diagnosis of acute myocarditis, due to its unique potential for non-invasive identification of the various hallmarks of the inflammatory response, with relevant impact on patient management and prognosis. Nonetheless, a marked variation in sensitivity and negative predictive value has been reported in the literature, reflecting the intrinsic drawbacks of current diagnostic criteria, which are based mainly on the use of conventional CMR pulse sequences. As a consequence, a negative exam cannot reliably exclude the diagnosis, especially in patients who do not present an infarct-like onset of disease. The introduction of new-generation mapping techniques further widened CMR potentials, allowing quantification of tissue changes and opening new avenues for non-invasive workup of patients with inflammatory myocardial disease. CMR sensitivity varies in AM, reflecting its clinical polymorphism and the intrinsic drawbacks of LLc. Semiquantitative approaches such as EGEr or T2 ratio have limited accuracy in diffuse disease forms. T1 mapping allows objective quantification of inflammation, with no need to normalize measurements. A revised protocol including T2-STIR, T1 mapping and LGE could be hypothesized to improve sensitivity.


Pulakazhi Venu V.K.,University of Milan | Uboldi P.,University of Milan | Dhyani A.,University of Milan | Patrini A.,University of Milan | And 7 more authors.
Thrombosis and Haemostasis | Year: 2015

The primary transcript of fibronectin undergoes alternative splicing in the cassette-type EDA and EDB exons and in the IIICs segment to generate different protein isoforms. Human carotid atherosclerotic plaques with a more stable phenotype are enriched with EDA containing fibronectin (FN-EDA). The aim of this study was to investigate the role of EDA containing fibronectin during atherogenesis. Mice constitutively expressing or lacking the EDA domain of fibronectin (EDA+/+ or EDA-/-) were crossed with ApoE-/- or LDL-R-/- mice and fed with a western type diet for 12 weeks. Lack of FN-EDA resulted in reduced atherosclerosis and in a plaque phenotype characterised by decreased calponin positive VSMC’s (-15 %) and increased macrophages (+20 %). This was paralleled by increased MMP2, MMP9, and reduced TIMP2, collagen 1A1, 1A2 and 3A1 gene expression compared to that of wild-type and EDA+/+ mice. In vitro, VSMCs and macrophages isolated from EDA-/- mice showed increased MMPs expression and activity compared to wild-type or EDA+/+ mice. Albumin-Cre recombinase/ EDA+/+/ApoE-/- mice, which produce EDA containing FN only in peripheral tissues, presented an extension, a composition and a gene expression pattern in the atherosclerotic lesions similar to that of controls. The inclusion of EDA in FN results in larger atherosclerotic plaques compared to mice lacking EDA but with a more favourable phenotype in two animals models of atherosclerosis. This effect depends on the EDA-containing fibronectin produced by cells in the vasculature but not in the liver. These observations set the stage for investigating the properties of circulating EDA containing FN in improving plaque stability. © Schattauer 2015.


Caiani E.G.,Polytechnic of Milan | Colombo A.,Polytechnic of Milan | Pepi M.,IRCCS Centro Cardiologico Monzino | Piazzese C.,Polytechnic of Milan | And 3 more authors.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology | Year: 2014

AIMS: To propose a nearly automated left ventricular (LV) three-dimensional (3D) surface segmentation procedure, based on active shape modelling (ASM) and built on a database of 3D echocardiographic (3DE) LV surfaces, for cardiac magnetic resonance (CMR) images, and to test its accuracy for LV volumes computation compared with 'gold standard' manual tracings and discs-summation method.METHODS AND RESULTS: The ASM was created based on segmented LV surfaces (4D LV analysis, Tomtec) from 3DE datasets of 205 patients. Then, it was applied to the cardiac magnetic resonance imaging short-axis (SAX) images stack of 12 consecutive patients. After proper realignment using two- and four-chambers CMR long-axis views both as reference and for initializing LV apex and base (six points in total), the ASM was iteratively and automatically updated to match the information of all the SAX planes contemporaneously, resulting in an endocardial LV 3D mesh from which volume was directly derived. The same CMR images were analysed by an experienced cardiologist to derive end-diastolic and end-systolic volumes. Linear correlation and Bland-Altman analyses were applied vs. the manual 'gold standard'. Active shape modelling results showed high correlations with manual values both for LV volumes (r(2) > 0.98) and ejection fraction (EF) (r(2) > 0.90), non-significant biases and narrow limits of agreement.CONCLUSION: The proposed method resulted in accurate detection of 3D LV endocardial surfaces, which lead to fast and reliable measurements of LV volumes and EF when compared with manual tracing of CMR SAX images. The segmented 3D mesh, including a realistic LV apex and base, could constitute a novel starting point for more realistic patient-specific finite element modelling. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.


PubMed | University of Padua, Julio Jasolino Thermal Study Center, ASL Naples 2 Nord, University of Naples Federico II and 3 more.
Type: Comparative Study | Journal: Clinical and experimental rheumatology | Year: 2016

To evaluate the efficacy and safety of combined treatment of mud-bath therapy and glucosamine crystalline sulfate (GlcN-S) in patients with knee osteoarthritis (OA).This study was a randomised, controlled, crossover investigation. Patients were randomly assigned (1:1) by the investigators to two groups, named group 1 and 2. Group 1 included twenty-three patients receiving oral GlcN-S treatment from the beginning of the study (T0) to the end of the 3rd month of treatment (T3) and a combined treatment of both mud-bath therapy and GlcN-S from T3 to the end of the study at six months (T6). Group 2 included twenty-two patients receiving a combined treatment of both mud-bath therapy and GlcN-S from T0 to T3 and that discontinued mud-bath therapy, receiving GlcN-S treatment alone, from T3 to T6. Primary endpoints of the study consisted of evaluating OA severity and activity at baseline and at follow-up visits.All 45 patients, eligible for the study, completed the period of the crossover. In group 1, no significant difference was shown in the comparison from T0 to T3, while from T3 to T6 most variables were significantly improved. In group 2, instead, the comparison between T0 and T3 showed a significant difference in different parameters. When comparing T3 and T6, despite an improvement of all the variables, no significant difference was shown.The association of GlcN-S and mud-bath therapy has a positive and safe role in improving pain, function and quality of life in knee OA patients.


PubMed | Ospedale di Villa DAgri, IRCCS Centro Cardiologico Monzino, University of Padua, Policlinico S. Orsola and 12 more.
Type: Clinical Study | Journal: La Radiologia medica | Year: 2015

Cardiac CT (CCT) is an imaging modality that is becoming a standard in clinical cardiology. We evaluated indications, safety, and impact on patient management of routine CCT in a multicenter national registry.During a period of 6months, 47 centers in Italy enrolled 3,455 patients.CCT was performed mainly with 64-slice CT scanners (73.02%). Contrast agents were administrated in 3,185 patients (92.5%). Mean DLP changes with type of scanner and was lower in >64 row detector scanner. The most frequent indication for CCT was suspected CAD (44.8%), followed by calcium scoring (9.6%), post-angioplasty/stenting (8.3%), post-CABGs (7.5%), study of cardiac anatomy (4.22%) and assessment in patients with known CAD (4.1%) and acute chest pain (1.99%). Most of the CCTs were performed in outpatient settings (2,549; 74%) and a minority in inpatient settings (719, 20.8%). Adverse clinical events (mild-moderate) occurred in 26 examinations (0.75%). None of them was severe. In 45.3% of the cases CCT findings impacted patient management.CCT is performed with different workloads in participating centers. It is a safe procedure and its results have a strong impact on patient management.


PubMed | Azienda Ospedaliera Universitaria G. Martino, Erasmus Medical Center, Policlinico S. Orsola Bologna, University Cattolica Rome and 11 more.
Type: Journal Article | Journal: European journal of radiology | Year: 2014

Forty sites were involved in this multicenter and multivendor registry, which sought to evaluate indications, spectrum of protocols, impact on clinical decision making and safety profile of cardiac magnetic resonance (CMR).Data were prospectively collected on a 6-month period and included 3376 patients (47.2 19 years; range 1-92 years). Recruited centers were asked to complete a preliminary general report followed by a single form/patient. Referral physicians were not required to exhibit any specific certificate of competency in CMR imaging.Exams were performed with 1.5T scanners in 96% of cases followed by 3T (3%) and 1T (1%) magnets and contrast was administered in 84% of cases. The majority of cases were performed for the workup of inflammatory heart disease/cardiomyopathies representing overall 55.7% of exams followed by the assessment of myocardial viability and acute infarction (respectively 6.9% and 5.9% of patients). In 49% of cases the final diagnosis provided was considered relevant and with impact on patients clinical/therapeutic management. Safety evaluation revealed 30 (0.88%) clinical events, most of which due to patients preexisting conditions. Radiological reporting was recorded in 73% of exams.CMR is performed in a large number of centers in Italy with relevant impact on clinical decision making and high safety profile.


Gennari M.,Cardiac Surgery Unit | Gambini E.,IRCCS Centro Cardiologico Monzino | Bassetti B.,IRCCS Centro Cardiologico Monzino | Capogrossi M.,IRCCS Instituto Dermopatico dellImmacolata | Pompilio G.,Cardiac Surgery Unit
Reviews in Cardiovascular Medicine | Year: 2014

A challenge of modern cardiovascular medicine is to find new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy. These patients are not candidates for surgical or percutaneous revascularization. Herein we review the most up-to-date information regarding the modern approach to the patient with refractory angina pectoris, from conventional medical management to new medications and shock wave therapy, focusing on the use of endothelial precursor cells (EPCs) in the treatment of this condition. Clinical limitations of the efficiency of conventional approaches justify the search for new therapeutic options. Regenerative medicine is considered the next step in the evolution of organ replacement therapy. It is driven largely by the same health needs as transplantation and replacement therapies, but it aims further than traditional approaches, such as cell-based therapy. Increasing knowledge of the role of circulating cells derived from bone marrow (EPCs) on cardiovascular homeostasis in physiologic and pathologic conditions has prompted the clinical use of these cells to relieve ischemia. The current state of therapeutic angiogenesis still leaves many questions unanswered. It is of paramount importance that the treatment is delivered safely. Direct intramyocardial and intracoronary administration has demonstrated acceptable safety profiles in early trials, and may represent a major advance over surgical thoracotomy. The combined efforts of bench and clinical researchers will ultimately answer the question of whether cell therapy is a suitable strategy for treatment of patients with refractory angina. © 2014 MedReviews®, LLC.

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