Giacomo Pongiglione

Exercise capacity in apparently healthy survivors of cancer

Aims: To evaluate cardiopulmonary exercise tolerance in a large cohort of apparently healthy paediatric cancer survivors in order to determine their participation in sporting activities. Methods: A total of 84 young (<21 years) asymptomatic childhood cancer survivors, who had been exposed to anthracyclines (mean dose 212 mg/m2) and/or chest irradiation (median dose 2000 cGy), with normal left ventricular systolic function at rest (fractional shortening >29%), and 79 healthy controls were studied. Exercise testing was performed on a treadmill ergometer. Gas exchange analysis and derived variables were measured on a breath-by-breath basis. Pulmonary functional evaluation was performed before exercise. Echocardiographic evaluation at rest was performed within one month before the exercise test. Results: There were no differences in exercise responses between patients and controls. In boys <13 years, mean VO2 max was slightly but significantly lower than in controls. This finding was thought to be a result of decreased physical fitness as all the other exercise parameters were similar to those in the controls. Conclusions: Results show that apparently healthy survivors of paediatric cancer can take part in dynamic sporting activities if they exhibit a normal response to cardiopulmonary exercise testing, while those that exhibit a reduced VO2 max should be re-evaluated after an aerobic training programme, and should undergo tailored dynamic physical activity if the VO2 max does not normalise.

Percutaneous closure of patent foramen ovale in patients with presumed paradoxical embolism: Periprocedural results and midterm risk of recurrent neurologic events

OBJECTIVEnTo report our data on selected patients with previous paradoxical embolism who underwent transcatheter patent foramen ovale (PFO) closure.nnnMETHODSnBetween July 2001 and July 2007, percutaneous PFO closure was performed on 128 patients (65 women, mean age: 46 +/- 12.8 years). Patent foramen ovale closure was recommended for secondary prevention in patients with previous transient ischemic attacks (52.5%), stroke (46%), or peripheral embolism (1.5%).nnnRESULTSnImplantation was successful in all patients, and at the end of intervention, complete PFO closure was achieved in 70.3% of them. There were no major complications (ie, deaths, device embolization or thrombosis, need for cardiac surgery). The overall incidence of complications (mostly hemorrhagic) was 7%. The mean follow-up period was 32 months. Complete closure had been achieved in 78.4% and in 82.5% of patients at the third month of transesophageal echocardiography examination and at the sixth month of transcranial Doppler examination, respectively. There were no recurrent thromboembolic events during the follow-up period.nnnCONCLUSIONSnPercutaneous closure of PFO is a feasible procedure, but it is not a risk-free technique. However, in correctly selected patients (ie, large PFO and those at risk for neurologic relapse), nearly complete PFO closure seems to provide protection from future neurologic ischaemic events at midterm follow-up.

Percutaneous rescue of left ventricular embolized amplatzer septal occluder device

Transcatheter atrial septal defect (ASD) closure has proven to be safe and effective, and it is rapidly becoming the standard treatment for secundum‐type ASDs. However, device embolization occurs in about 0.55% of cases, regardless of ASD and device size and/or physicians expertise. Percutaneous retrieval of the embolized device is possible in about 50% of cases, and several techniques have been described, including the use of large sheaths, gooseneck snares, or bioptomes. This is the first successful and reported case of retrieval of an embolized amplatzer septal occluder (ASO) from the left ventricle that was achieved by using a modified snare technique. This was done after an unsuccessful attempt at retrieval with a bioptome that led to a never previously reported complication. Of the 32 reported cases of ASO embolization, percutaneous retrieval was successful in 16 cases (50%) and none were obtained following left ventricular embolization. Even in experienced hands, the observed rate of embolization when using an ASO device is not negligible. Percutaneous retrieval is also possible from the left ventricle but in some cases nonstandardized devices and strategies may be required.

Stenting of aortic coarctation and exercise-induced hypertension in the young

To evaluate whether the stenting of aortic coarctation enhance the risk of exercise‐induced hypertension (EIH).

Interruption of the aortic arch, ventricular septal defect, aortic atresia and aortopulmonary fistulous communication

Interruption of the aortic arch in association with aortic atresia is a rare condition. We report the second case in literature in which survival was provided by an aortopulmonary fistulous communication.

Percutaneous transluminal angioplasty of the left internal thoracic artery graft: a case report of a child operated on for anomalous origin of the left coronary artery from the pulmonary artery.

Abstract. We report a case of an 8-year-old girl operated on with left internal thoracic artery–coronary artery anastomosis for anomalous left coronary artery from the pulmonary artery, in whom an early stenosis of the graft was successfully treated by percutaneous transluminal angioplasty.

Divided left atrium (cor triatriatum sinistrum) presenting with syncope

Syncope has never been described as the presenting symptom of divided left atrium (cor triatriatum sinistrum). We have now encountered this mode of presentation in an otherwise asymptomatic patient. An upright tilt test elicited syncope prior to surgical correction, but failed to induce any symptom, even subsequent to infusion of isoproterenol, after surgery.