Carmelo Arcidiacono

Right and Left Ventricular Strain and Strain Rate in Young Adults before and after Percutaneous Atrial Septal Defect Closure

To evaluate acute change of right and left ventricle after percutaneous closure of isolated atrial septal defect (ASD) 21 adult patients (13 F; 8 M) aged 28 ± 9.5 range 18–49 years have been examined by echocardiography before and 24 hours after percutaneous closure of ASD. Twenty‐one normal adult subjects, as control group were included. A MyLab25 echo machine equipped with a multifrequency 2.5–3.5 MHz transducer was used. Offline computer‐based analysis for strain and SR were performed using XStrain software based on a feature tracking algorithm. All patients had ASD OS2 with right ventricular dilatation and diastolic areas were larger than in controls: P = 0.0158. Global right ventricular longitudinal strain was higher P = 0.0438. Twenty‐four hours after ASD closure, right ventricular diastolic and systolic areas were significantly reduced. Right ventricular global longitudinal systolic strain decreased: P = 0.00016, as well as global right ventricular longitudinal SR –1.56/sec ± 0.57 vs. –1.28/sec ± 0.31, P = 0.02646. At the mean time left ventricular end diastolic volume and left ventricular cardiac output measured by two‐dimensional echocardiography both increased significantly P = 0.002145 and 0.013409. Global circumferential strain at mitral level augmented significantly –20.3%± 4.64 vs. –25.39%± 5.22, P = 0.00003. Longitudinal strain of the right ventricle works as indicator of right ventricular function dependent on loading conditions while SR seems to be less dependent on it. Circumferential strain could be used as an indicator of left ventricular response to normalized loading conditions. (Echocardiography 2011;28:730‐737)

Fenestrated Amplatzer atrial septal defect occluder in an elderly patient with restrictive left ventricular physiology

A 76-year-old man with an atrial septal defect (ASD) had a large left to right shunt, dilated right ventricle and raised estimated pulmonary arterial pressure of 62 mmHg on echocardiography, portending high risk closure. Haemodynamically it was evaluated by test occlusion and sizing with a 24 mm Amplatzer sizing balloon, monitoring left ventricular (LV) pressure via a pigtail catheter for 10 min (figure 1A–C). LV pressure rose from 92/15 to 111/30 mmHg. A 22 mm ASD occluder (AGA Medical, Plymouth, Minnesota, USA) …

Covered-stent implantation to treat aortic coarctation

Aortic coarctation comprises approximately 7% of all known congenital heart defects. Surgery and balloon angioplasty have been performed for many years but are associated with a significant incidence of recoarctation and aneurysm formation. Although bare-stent implantation decreases the incidence of recoarctation, the risk of aortic dissection or aneurysm formation is not eliminated. Described initially to treat patients with coexistent aneurysm of the aortic wall, we currently believe that covered-stent implantation for aortic coarctation should play a more important role. Our increasing experience from expanding their indication to deal with complications from previous interventions, associated defects or particular anatomical situations has led us to conclude that most of cases of aortic coarctation in adolescents and adults should be treated by the implantation of covered stents.

Echocardiographic assessment after surgical repair of tetralogy of fallot.

Surgical correction of tetralogy of Fallot is still one of the most frequently performed intervention in pediatric cardiac surgery, and in many cases, it is far from being a complete and definitive correction. It is rather an excellent palliation that solves the problem of cyanosis, but predisposes the patients to medical and surgical complications during follow-up. The decision-making process regarding the treatment of late sequel is among the most discussed topics in adult congenital cardiology. In post-operative Fallot patients, echocardiography is used as the first method of diagnostic imaging and currently allows both a qualitative observation of the anatomical alterations and a detailed quantification of right ventricular volumes and function, of the right ventricular outflow tract, and of the pulmonary valve and pulmonary arteries. The literature introduced many quantitative echocardiographic criteria useful for the understanding of the pathophysiological mechanisms involving the right ventricle and those have made much more objective any decision-making processes.

Percutaneous Closure of Multiple Secundum Atrial Septal Defects Using 3 Amplatzer Atrial Septal Occluder Devices Evaluation by Live Transthoracic 3-Dimensional Echocardiography

A previously healthy 12-year-old boy was admitted to the hospital with acute pneumonitis. On admission, a heart murmur was detected. The transthoracic echocardiogram showed multiple secundum atrial septal defects with left-to-right shunt and signs of right ventricular volume overload. He underwent right cardiac catheterization and transesophageal echocardiogram (transesophageal echocardiography): 3 sizeable atrial septal defects (anterosuperior, measuring 10 mm; posterior, 9 mm; anteroinferior, 6 mm) were closed with …

Role of imaging in interventions on structural heart disease

Recent technological progresses have led to the development of new devices and procedures which have greatly improved the chance to effectively treat structural heart diseases in both children and adults. Interventional cardiology has been receiving fast and wide implementation as an effective alternative treatment to surgery for several congenital and acquired diseases. The advent of transcatheter valve implantation/repair techniques constitutes one of the main breakthroughs of the last decades. Such development and implementation is strictly related to a continuous progress in cardiac imaging as well. Indeed, multimodality cardiac imaging (such as X-ray, echocardiography, MRI, multidetector computed tomography) has become essential in providing accurate patient selection and in monitoring the interventional procedures in order to optimize the success rate and minimize the frequency of complications. The current article aims at reviewing the role of multimodality imaging for planning and guiding interventions in several structural heart diseases.

Surgical mitral valve replacement with the Melody valve in infants and children: the Italian experience

AIMS Paediatric patients with mitral valve (MV) disease have limited options for prosthetic MV replacement. Based on long experience with the stented bovine jugular vein graft (Melody valve) in the right ventricular outflow tract, we aimed to test the use of the Melody valve as a surgical implant in the mitral position in a small group of infants with congenital mitral disease. METHODS AND RESULTS Eight patients, aged from 3 months to 6.2 years, with congenital MV dysplasia underwent Melody valve implantation in the mitral position between March 2014 and October 2015. Once sutured to the MV annulus, the Melody valve was expanded through a balloon catheter to achieve the best diameter (12-20 mm). Two patients needed ECMO assistance after traditional MV repair and a Melody valve was successfully implanted as possible bail-out. However, neither of them recovered from multi-organ failure and both died, in spite of the well-functioning Melody prosthesis. During follow-up, only one patient underwent catheter-based balloon expansion of the valve. CONCLUSIONS The medium-term results of this procedure are encouraging. The Melody valve opens up the opportunity to carry out MV replacement in more children at an earlier time point, and it has potential to revolutionise the treatment of MV disease.

Treatment of right ventricular outflow tract dysfunction: a multimodality approach

The right timing to replace the pulmonary valve in a patient with dysfunction of the right ventricular outflow tract is unknown. Both percutaneous pulmonary valve and surgical prosthesis are suitable options. In every patient, the right ventricle (RV) remodels and recovers differently after pulmonary replacement. Therefore, it is difficult to identify the best treatment option and to predict the long-term results. In the last few years, we focused our research on optimizing the characterization of these patients through advanced cardiovascular imaging in order to find possible variables, parameters, and reproducible measurements that can help us in the decision-making process. The aim of the present article is to present our ongoing research lines that focus on the characterization and optimal treatment approach to the dysfunction of the RVOT.

Cardiovascular Physiology, Pathology, and Clinical Investigation

Congenital heart defects (CHD) are a heterogeneous entity, representing the most common malformations in the fetal and neonatal period. The incidence of moderate to severe structural CHD that will require expert cardiologic care is 2.5 to 3 per 1000 live births. Moderately severe forms of CHD probably account for another 3 per 1000 live births. Specialised cardiologic care is not needed for most minor forms of CHD, such as tiny ventricular septal defect (VSD) or atrial septal defect (ASD) [1]. Most infants with congenital heart disease are identified by the end of neonatal period.

Early Diagnosis of Congenital Heart Disease: When and How to Treat

Cardiovascular malformation is the most common group of congenital malformations. The prevalence is 5.3 cases per 1000 live births [1, 2, 3]. These malformations represent a significant cause of neonatal morbidity and mortality. Advances in medical and surgical treatment of congenital heart disease (CHD) have resulted in a trend towards an improved outcome in conditions which previously carried high mortality. The antenatal diagnosis of CHD, by fetal echocardiography carries important advantages: 1) prenatal diagnosis is associated with less hypoxia, preoperative acidosis, fewer neurologic events, and early age to surgery [4]; 2) it provides opportunities for parental counseling; 3) it may optimize perinatal care in terms of changes in obstetric and neonatal management with multidisciplinary approach which should reduce mortality and morbility [5,6]. Routine neonatal examination fails to detect many affected babies, because a normal examination does not exclude serious cardiac malformation, including hypoplastic left heart syndrome or other pathologies such as interruption or coarctation of the aortic arch. Considering that about half of the babies with cardiac murmur, detected over the first few days of life, have a structural heart disease [7], these patients should be referred for early pediatric cardiological evaluation and definitive diagnostic echocardiography. Unrecognized neonatal cardiac malformation carries a serious risk of avoidable mortality, morbidity and handicap [8]. Regardless of this, all syndromic babies such as Down syndrome-affected babies who have a high prevalence of congenital heart disease, should be referred for early echocardiographic examination [1]. The key point is that echocardiography is an essential tool in the evaluation of neonates and has dramatically improved the accuracy of diagnosis of congenital heart disease.