Operative Unit of Cardiology

Massa, Italy

Operative Unit of Cardiology

Massa, Italy
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Tasca G.,Operative Unit of Cardiac Surgery | Tasca G.,Polytechnic of Milan | Tasca G.,Operative Unit of Cardiology | Redaelli P.,Operative Unit of Cardiac Surgery | And 4 more authors.
Journal of Cardiac Surgery | Year: 2015

Background Patients with a small aortic annulus, that is ≤23 mm, constitute a challenge for the surgeon, because they are at high risk of patient-prosthesis mismatch. Stentless valves provide better hemodynamic performance at rest and during exercise than stented valves, and are advocated in this group of patients. A new-generation stented valve, the Trifecta (St. Jude), has recently become available with improved hemodynamics. The aim of this study was to compare the hemodynamic performance of Freestyle (Medtronic) and Trifecta at rest and during exercise in patients with a small aortic annulus. Methods From September 2012 to September 2014, 22 patients with a native aortic annulus ≤23 mm underwent ergometric stress testing one year after aortic valve replacement with either a Trifecta (12 patients) or a Freestyle (10 patients) bioprosthesis as part of a randomized study. Results The mean gradient at rest was 6.0 ± 2.3 mmHg for Trifecta and 4.3 ± 3.5 for Freestyle (p = 0.213). The mean gradient at peak of exercise was 9.7 ± 3.4 mmHg for Trifecta and 7.4 ± 5 mmHg for Freestyle (p = 0.243). No significant differences were found between the two prostheses regarding other hemodynamic parameters: effective orifice area, velocity index, and performance indexes. Conclusion Both the stented Trifecta and stentless Freestyle prostheses provide excellent hemodynamic results during physical stress in patients with a small aortic annulus. Our study confirms that Trifecta implantation results in low gradients at rest and during exercise and that the performance of Trifecta is similar to that of a stentless valve. © 2015 Wiley Periodicals, Inc.


Coppola L.,The Second University of Naples | Mastrolorenzo L.,The Second University of Naples | Coppola A.,Operative Unit of Cardiology | De Biase M.,The Second University of Naples | And 7 more authors.
International Journal of Geriatric Psychiatry | Year: 2013

Objective The aim of this research was to investigate relationships between cognitive function and non-invasive, repeatable cardiac parameters in elderly subjects suffering from mild cognitive impairment (MCI) or Alzheimer's disease (AD). Methods Two hundred and twenty-four community-living elderly subjects, 31 AD patients, 77 MCI patients, and 116 cognitively normal subjects (CNS), were evaluated for cognitive abilities (Mini Mental State Examination score (MMSE)) and for electrocardiographic [corrected heart rate QT interval dispersion (QTcD)] and echocardiographic [Left ventricular ejection fraction (LVEF)] parameters. Results Mean values of LVEF were not significantly different between the three groups; QTcD mean values were significantly lower in CNS group than in subjects with MCI and AD. The Pearson Product Moment Correlation test, carried out in the three study groups, showed a significant inverse correlation between QTcD and MMSE score (r = -0.357; p < 0.01) in the group of MCI patients, only. In multivariable-adjusted linear regression tests, QTcD (p = 0.030) and education (p = 0.021) are associated with MMSE score in MCI group. Only the parameter of education appears to predict MMSE in CNS group; none of these parameters appear to predict MMSE in the group of patients with AD. Conclusion The association between QTcD and MMSE requires cautious interpretation and further extensive investigation. However, if confirmed by longitudinal studies, the finding could play a role in the management of the subjects with MCI. Copyright © 2012 John Wiley & Sons, Ltd.


Gianetti J.,Operative Unit of Cardiology | Parri M.S.,Operative Unit of Cardiology | Della Pina F.,Operative Unit of Cardiology | Marchi F.,Operative Unit of Cardiology | And 4 more authors.
The Scientific World Journal | Year: 2013

Von Willebrand factor (VWF) is an emerging risk factor in acute coronary syndromes. Platelet Function Analyzer (PFA-100) with Collagen/Epinephrine (CEPI) is sensitive to functional alterations of VWF and also identifies patients with high on-treatment platelet reactivity (HPR). The objective of this study was to verify the effect of double dose (DD) of aspirin and clopidogrel on HPR detected by PFA-100 and its relation to VWF and to its regulatory metalloprotease ADAMTS-13. Between 2009 and 2011 we enrolled 116 consecutive patients with ST elevation myocardial infarction undergoing primary PCI with HPR at day 5 after PCI. Patients recruited were then randomized between a standard dose (SD, n = 58) or DD of aspirin and clopidogrel (DD, n = 58), maintained for 6 months follow-up. Blood samples for PFA-100, light transmittance aggregometry, and VWF/ADAMTS-13 analysis were collected after 5, 30, and 180 days (Times 0, 1, and 2). At Times 1 and 2 we observed a significantly higher CEPI closure times (CT) in DD as compared to SD (P < 0.001). Delta of CEPI-CT (T 1 - T 0) was significantly related to VWF (P < 0.001) and inversely related to ADAMTS-13 (0.01). Responders had a significantly higher level of VWF at T 0. Finally, in a multivariate model analysis, VWF and ADAMTS-13 in resulted significant predictors of CEPI-CT response (P = 0.02). HRP detected by PFA-100 in acute myocardial infarction is reversible by DD of aspirin and clopidogrel; the response is predicted by basal levels of VWF and ADAMTS-13. PFA-100 may be a useful tool to risk stratification in acute coronary syndromes given its sensitivity to VWF. © 2013 Jacopo Gianetti et al.


Gamba A.,Operative Unit of Cardiac Surgery | Tasca G.,Operative Unit of Cardiac Surgery | Giannico F.,Operative Unit of Cardiac Surgery | Lobiati E.,Operative Unit of Cardiology | And 4 more authors.
Annals of Thoracic Surgery | Year: 2015

Background The aim of this retrospective study was to evaluate our experience of using a simplified aortic valve sleeve procedure to treat aortic root ectasia and aneurysms with or without aortic regurgitation. In experienced hands, 2 aortic valve-sparing procedures, ie, Yacoub and David, have yielded excellent long-term results in the treatment of aortic root aneurysms, with or without aortic regurgitation. However, these techniques are demanding and not widely used. Recently, a new and simplified valve-sparing technique, named "sleeve procedure," has been proposed, and has yielded encouraging early results. Methods Ninety consecutive patients with aortic root aneurysms underwent sleeve procedures from October 2006 to October 2012. Follow-up data (clinical 100% complete and echocardiographic 93% complete) were acquired from our outpatient clinic or from the referring cardiologist. Results The mean age of the patients was 61.5 ± 12.5 years, 79% were male, 16 (18%) had a bicuspid valve, 3 had Marfan syndrome, and 2 had aortic dissection. Over a mean clinical follow-up of 34 ± 19 months, 2 patients died from noncardiac causes and 1 was reoperated on for the recurrence of aortic regurgitation. On follow-up echocardiography after a mean of 18 ± 9 months, aortic regurgitation was absent/negligible, mild or moderate in 62%, 37%, and 1% of patients, respectively, and the diameters of the annulus, Valsalva sinuses, and sinotubular junction were 27.3 + 2.2, 37.0 + 3.4, and 30.6 + 3.1 mm, respectively. Conclusions Our encouraging early and medium term results suggest that the sleeve procedure is a safe and effective aortic valve-sparing technique for the treatment of aortic root ectasia and aneurysm. However, longer follow-up is needed in order to draw definitive conclusions. © 2015 The Society of Thoracic Surgeons.


Ciccarone G.,Section of Sports Medicine | Martelli G.,Performance Medical and Rehabilitative Center | Ismael M.,Section of Sports Medicine | Scalchi G.,Operative Unit of Cardiology | Bilardo G.,Operative Unit of Cardiology
Medicina dello Sport | Year: 2013

Ostium secundum atrial septal defect (ASDII) is a common congenital heart defect. We report a case of a 12-year old female athlete during a precompetitive sports medicine examination. All cardiorespiratory and orthopedic objective values were negative, as well as clinic-instrumental examinations, spirometry, resting ECG and the maximal ergomet-ric test. Family history was positive for two young sudden deaths. Echocardiography showed an ostium secundum atrial septal defect (ASDII) with an initial volume overload of the heart right sections. Moreover it has been recently observed that ASDII resulted often associated with transcription factor NKX2.5 mutations. In this respect we could hypothesized, in our clinical case, a link between the athlete's pathology and the two familiar sudden deaths, thus suggesting to carry on further genetic researches.


Marfella R.,The Second University of Naples | Luongo C.,The Second University of Naples | Coppola A.,Operative Unit of Cardiology | Luongo M.,The Second University of Naples | And 8 more authors.
Atherosclerosis | Year: 2010

Background/aims: Inflammatory mediators contribute to the impairment of vasculogenesis by reducing endothelial progenitor cells (EPCs) mobilization in atherosclerotic vasculopathy. We tested the hypothesis that administration of an oxygen/ozone mixture (IMT) might counteract this pathophysiological mechanism and enhance limb tissue perfusion in patients with critical limb ischemia (CLI). Methods: Randomized patients with rest pain or ischemic ulcers and transcutaneous oxygen tension (TcPO2) <40 mmHg and/or toe pressure <50 mmHg received placebo (n = 74) or a non-specific immunomodulation therapy (IMT) (n = 77), autologous blood exposed to oxygen/ozone gas mixture by intragluteal injection, on day 1, 2, 7, and once a week thereafter for at least 22 weeks. Patients were evaluated for changes in TcPO2, levels of circulating EPCs (CD34/KDR-positive cells) and inflammation (tumor necrosis factor-α-TNF-α). Results: TcPO2 and CD34/CD133-positive cells increased at 22 weeks in IMT group (P < 0.01) whereas no changes were observed in placebo group. TNF-α levels decreased at 6 months in IMT group (P < 0.001) whereas no changes were observed in placebo group. There was a strong positive correlation between CD34/KDR-positive cells and TcPO2 (r = 0.56, P < 0.01). Moreover, there was an inverse correlation between CD34/KDR-positive cells and TNF-α (r = -0.51, P < 0.01). Conclusions: Intramuscular injection of IMT may improve wound healing and limb salvage in patients with CLI. © 2009 Elsevier Ireland Ltd. All rights reserved.


PubMed | Operative Unit of Cardiac Surgery and Operative Unit of Cardiology
Type: Journal Article | Journal: The Annals of thoracic surgery | Year: 2015

The aim of this retrospective study was to evaluate our experience of using a simplified aortic valve sleeve procedure to treat aortic root ectasia and aneurysms with or without aortic regurgitation. In experienced hands, 2 aortic valve-sparing procedures, ie, Yacoub and David, have yielded excellent long-term results in the treatment of aortic root aneurysms, with or without aortic regurgitation. However, these techniques are demanding and not widely used. Recently, a new and simplified valve-sparing technique, named sleeve procedure, has been proposed, and has yielded encouraging early results.Ninety consecutive patients with aortic root aneurysms underwent sleeve procedures from October 2006 to October 2012. Follow-up data (clinical 100% complete and echocardiographic 93% complete) were acquired from our outpatient clinic or from the referring cardiologist.The mean age of the patients was 61.5 12.5 years, 79% were male, 16 (18%) had a bicuspid valve, 3had Marfan syndrome, and 2 had aortic dissection. Over a mean clinical follow-up of 34 19 months, 2 patients died from noncardiac causes and 1 was reoperated on for the recurrence of aortic regurgitation. On follow-up echocardiography after a mean of 18 9 months, aortic regurgitation was absent/negligible, mild or moderate in 62%, 37%, and 1% of patients, respectively, and the diameters of the annulus, Valsalva sinuses, and sinotubular junction were 27.3+ 2.2, 37.0+ 3.4, and 30.6+3.1 mm, respectively.Our encouraging early and medium term results suggest that the sleeve procedure is a safe and effective aortic valve-sparing technique for the treatment of aortic root ectasia and aneurysm. However, longer follow-up is needed in order to draw definitive conclusions.

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