Cristina Capogrosso

Prolonged left ventricular twist in cardiomyopathies: a potential link between systolic and diastolic dysfunction.

AIMS Left ventricular (LV) twist and untwist play a major role in LV mechanics. We sought to acquire new pathophysiological insights in cardiomyopathies (CM) studying LV twist dynamics by speckle tracking imaging (STI). METHODS AND RESULTS Standard echo-Doppler and STI study were performed in 67 CM patients divided in four age- and sex-matched subgroups: 18 with apical hypertrophic cardiomyopathy (Group A); 20 with asymmetrical hypertrophic cardiomyopathy (Group B); 15 with dilated cardiomyopathy (Group C); 14 with LV non-compaction (Group D). As controls, 34 age- and sex-matched normal subjects were studied. Compared with control group, all CM Groups showed significantly lower longitudinal, circumferential, and radial myocardial deformations (P < 0.05). LV twist was correlated with ejection fraction (EF; r = 0.62; P < 0.0001). Furthermore, all CM patients had a significantly lower twist rate (P < 0.05) and delayed onset of untwist (P < 0.01). Of interest a significant correlation was found between isovolumic relaxation time and untwist onset (r= 0.485, P < 0.0001). In addition, a significant correlation was found between longitudinal deformations and the onset of untwist (strain: r = 0.46, P = 0.0001; strain rate: r = 0.33, P = 0.0056) and between longitudinal strain rate and twisting rate (r= -0.38; P = 0.0015). CONCLUSION (i) All CM patients show an impairment of longitudinal, circumferential, and radial myocardial deformations; (ii) LV peak twist is impaired only in CM with reduced EF but preserved in those with normal or increased EF; (iii) LV twist is prolonged and untwisting onset is delayed in all CM, suggesting that a mechanical adaptation to subclinical systolic abnormalities might induce, by a prolonged LV twist, the early onset of diastolic dysfunction.

Ten‐years, single‐center experience with arterial duct stenting in duct‐dependent pulmonary circulation: Early results, learning‐curve changes, and mid‐term outcome

To evaluate early results, learning‐curve changes, and mid‐term outcome of arterial duct (AD) stenting in congenital heart disease with duct‐dependent pulmonary circulation (CHD‐DPC) in a high‐volume, tertiary referral center.

Pulmonary artery growth after arterial duct stenting in completely duct-dependent pulmonary circulation.

Objective Significant and balanced pulmonary artery (PA) growth following arterial duct (AD) stenting has already been reported in literature. However, no data are so far available about the role of this percutaneous approach in promoting PA growth in the case of congenital heart disease (CHD) with completely duct-dependent pulmonary blood flow (CDD-PBF). Aim of this study was to evaluate the effect of AD stenting in this pathophysiological setting. Methods PA growth was evaluated as Nakata index and McGoon ratio as well as individual PA z-score changes in 49 patients submitted to neonatal AD stenting according to their pathophysiology (CDD-PBF (n=15) versus multiple PBF sources (n=34)). Results Control angiography was performed 7.2±6.4 months (range 1–8, median 6) after AD stenting. In the whole population, significant and balanced PA growth was recorded (Nakata index+122±117%; left pulmonary artery (LPA) z-score +84±52%; right pulmonary artery (RPA) z-score +92±53% versus preprocedure, p<0.0001 for all comparisons). Percentage increase of global and branch vessel size was not significantly different in patients with CDD-PBF compared with those with multiple PBF sources (Nakata index 89±90% vs 144±124%; LPA z-score 63±40% vs 89±58%; RPA z-score 74±35% vs 100±57%, p=NS for all comparisons) as was final absolute PA size (Nakata index 237±90 vs 289±80 mm2/m2, p=NS). Conclusions Percutaneous AD stenting was associated with significant and balanced PA growth in CHD with completely duct-dependent pulmonary circulation over a short-term follow-up. Thus, it may be considered as an alternative to surgical palliation in this subset of patients.

Off-label use of Amplatzer Duct Occluder II additional sizes.

Objective To report our experience on novel, off-label use of Amplatzer Duct Occluder type II additional sizes (ADO II-AS) device (St. Jude Medical, Inc.; St. Paul, Minnesota, USA) to manage nonduct shunt lesions. Methods and results Among the 114 patients submitted to ADO II-AS implantation at our institution, 12 received this device as off-label treatment of paravalvular leak (n = 5), sinus of Valsalva fissuration (n = 2), accessory atrial septal defect (n = 2), muscular ventricular septal defect (n = 1), bleeding bronchial artery aneurysm (n = 1) and reverse shunt due to abnormal origin of left subclavian artery from pulmonary artery (n = 1). Age and body weight of these patients ranged from 3 to 74 years and from 15 to 80 kg, respectively. All procedures were completed without anatomical, functional or ECG complications and without residual shunt. In one patient with mitral paravalvular leak, mild restriction of the posterior disc excursion after device deployment was recorded. Conclusion In our case series, ADO II-AS was well tolerated, versatile and cost-effective in treatment of different types of nonduct shunt lesions, mainly in young children and in older patients with comorbidities.

Single-center experience in percutaneous closure of arterial duct with Amplatzer duct Occluder II additional sizes

This study aimed to report a large, single‐center experience of percutaneous arterial duct (AD) closure using Amplatzer Duct Occluder II Additional Sizes device (ADO II‐AS)(St. Jude Medical Corp, St. Paul, MN, USA).

Multimodality Imaging of a Very Late Thrombosis of a Sutureless Aortic Prosthesis

An 80-year old woman was admitted to our department for syncope and worsening effort dyspnea (New York Heart Association functional class III). The patient underwent surgical aortic valve replacement with a 21-mm Enable (Medtronic, Irvine, California) sutureless valve 6 years before. Although follow

Subclinical Leaflet Thrombosis After Transcatheter Mitral Valve-in-Ring Implantation

A 66-year-old man with a history of ischemic cardiomyopathy (ejection fraction 35%) and severe functional mitral regurgitation underwent coronary artery bypass grafting and mitral valve repair by quadrangular resection of the posterior leaflet and 30-mm Carpentier-Edwards annuloplasty ring (Edwards

Interventional Imaging of the Tricuspid Valve

Nowadays, reasonable transcatheter tricuspid valve (TV) interventions are emerging as therapeutic options for functional tricuspid regurgitation (TR). The preprocedural planning is based on a multimodality imaging approach, which aims to (1) define the mechanisms of TR, (2) characterize TV morphology, (3) analyze the anatomic relationship between the TV apparatus and other structures, and (4) determine the size of the tricuspid annulus and vena cavae. Intraprocedural guidance is based mainly on transesophageal echocardiography (seldom transthoracic) and fluoroscopy, with the recent introduction of fusion imaging.

Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection

Aims A 3D transoesophageal echocardiography (3D-TOE) reconstruction tool has recently been introduced. The system automatically configures a geometric model of the aortic root and performs quantitative analysis of these structures. We compared the measurements of the aortic annulus (AA) obtained by semi-automated 3D-TOE quantitative software and manual analysis vs. multislice computed tomography (MSCT) ones. Methods and results One hundred and seventy-five patients (mean age 81.3 ± 6.3 years, 77 men) who underwent both MSCT and 3D-TOE for annulus assessment before transcatheter aortic valve implantation were analysed. Hypothetical prosthetic valve sizing was evaluated using the 3D manual, semi-automated measurements using manufacturer-recommended CT-based sizing algorithm as gold standard. Good correlation between 3D-TOE methods vs. MSCT measurements was found, but the semi-automated analysis demonstrated slightly better correlations for AA major diameter (r = 0.89), perimeter (r = 0.89), and area (r = 0.85) (all P < 0.0001) than manual one. Both 3D methods underestimated the MSCT measurements, but semi-automated measurements showed narrower limits of agreement and lesser bias than manual measurements for most of AA parameters. On average, 3D-TOE semi-automated major diameter, area, and perimeter underestimated the respective MSCT measurements by 7.4%, 3.5%, and 4.4%, respectively, whereas minor diameter was overestimated by 0.3%. Moderate agreement for valve sizing for both 3D-TOE techniques was found: Kappa agreement 0.5 for both semi-automated and manual analysis. Interobserver and intraobserver agreements for the AA measurements were excellent for both techniques (intraclass correlation coefficients for all parameters >0.80). Conclusion The 3D-TOE semi-automated analysis of AA is feasible and reliable and can be used in clinical practice as an alternative to MSCT for AA assessment.

ASD Closure in Special Situations: Elderly, PA-IVS

Transcatheter closure is nowadays considered as the first-choice treatment of atrial septal defect (ASD). However, indication, technique, and results of this approach are still challenging and under debate in particular settings, as in elderly or in patients with pulmonary atresia with intact ventricular septum (PA-IVS) submitted to right ventricular decompression.