Mario Salvatore Russo

Cryoablation of Typical Atrioventricular Nodal Reentrant Tachycardia in Children: Six Years’ Experience and Follow‐Up in a Single Center

Background: Cryoablation is an effective and safe treatment for children with supraventricular tachycardias when the reentry circuit is located near the atrioventricular (AV) junction. We retrospectively reviewed consecutive cryoablation procedures for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in children and young adults in a single pediatric center.

Atrial tachycardias in patients with congenital heart disease: a minimally invasive simplified approach in the use of three-dimensional electroanatomic mapping.

AIMS Atrial tachycardia (AT) is a common complication after repair of congenital heart disease (CHD). This two-centre prospective study evaluated the ability of three-dimensional electroanatomic mapping (EAM) to guide ablation of ATs in this particular population with a minimally invasive simplified approach. METHODS AND RESULTS Thirty-one consecutive patients (mean age 26 ± 17 years) with AT after repair of CHD were treated with a very limited number of intracavitary catheters and a specific setting of the Window of Interest (WoI) for the ablation of post-surgical ATs. A single-intracavitary catheter approach was performed in 22 patients, whereas an overall use of two intracavitary catheters in the other nine patients. Thirty-one patients exhibited 41 ATs. Seventy-six per cent of these were macro-reentrant ATs (MRATs), and 24% were focal ATs (FAT). The mid-diastolic isthmus (MDI) was located in the right atrial free wall (RAFW) in 82.8% of MRATs. Also in FATs, the RAFW was the most common site (77.8%) of the ectopic focus. Fifty-eight per cent of MRATs showed a double-loop reentry, with both loops sharing the same MDI in all cases. In 87% of cases, the abolition of the MRAT was obtained by applying radiofrequency energy to the MDI. Ninety per cent of FATs were successfully ablated. Mean conduction velocity and voltage amplitude had significantly lower values in successfully treated than in unsuccessfully treated MRATs. CONCLUSION Three-dimensional EAM, performed with a minimally invasive simplified approach and by using a specific parameter setting of the WoI, showed to be very effective to guide ablation of ATs in CHD patients.

Bifid T waves in leads V2 and V3 in children: a normal variant

IntroductionThe T wave is rarely bifid, apart from patients with long QT syndrome or subjects treated with antiarrhythmic drugs. At times, a U wave partially superimposed upon the T wave is responsible for an apparently bifid T wave. Bifid T waves, in contrast, have been described in normal children in the past, but the phenomenon has not received any attention in recent years, to the extent that it is not mentioned in current textbooks of paediatric cardiology. Aim of the present study was to determine the incidence and clinical counterpart of bifid T waves in a paediatric population.MethodsWe selected 604 consecutive children free from clinically detectable heart disease; subjects whose electrocardiogram showed a bifid T wave underwent a complete clinical and echocardiographic examination. In addition, the electrocardiograms of 110 consecutive adults have also been analyzed. A T wave was considered as bifid whenever it was notched, being the 2 peaks separated from each other by a notch with duration ≥ 0.02 sec and voltage ≥ 0.05 mV. Moreover, in 7 children with bifid T wave in lead V2 further precordial recordings were obtained: a small electrode was gradually moved from V1 to V3, and 4 additional leads were recorded: 2 between V1 an V2, and 2 between V2 and V3.ResultsA bifid T wave was observed in 110 children (18,3%), with a relatively age-related incidence; the highest rate of bifid T waves (53%) occurred in the group of 5-year-old children. The bifid T wave was detected only in lead V2 in 51 cases (46,4%), only in lead V3 in 5 cases (4,6%), in both leads V2 and V3 in 50 cases (45,4%), and in leads other than V2 and V3 in 4 cases (3,6%). In the adult group, none of the examined electrocardiograms showed bifid T waves in any lead.In the bifid T wave paediatric population, the echocardiogram did not reveal any abnormality, apart from 3 subjects which had an asymptomatic mitral valve prolapse; a trivial mitral and/or tricuspid regurgitation detected by color Doppler, as well as a patent foramen ovale in infants, were not considered as abnormal findings. The QTc interval was normal in all of the subjects; the average QTc interval was not different in the bifid T wave population (402 ± 46 msec) with respect to the control group (407 ± 39 msec).ConclusionThe incidence of bifid T waves in leads V2 and V3 in normal children is high, and awareness of this phenomenon avoids possible misinterpretations leading to a diagnosis of ECG abnormalities.

Carotid artery intima-media thickness and stiffness index β changes in normal children: role of age, height and sex.

Aims The need for early markers of atherosclerosis in paediatric ages has been emphasized recently. Few data are available on the behaviour of carotid intima-media thickness (cIMT) and arterial stiffness in normal children. Methods We studied prospectively 131 healthy children (78 boys), aged 3–16 years, by high-definition ultrasonography and echo-tracking technique in order to evaluate cIMT and stiffness index &bgr;. Results Stiffness index &bgr; underwent a significant age-related increase (P < 0.001), and a positive relationship between cIMT and height was found in boys. In addition, stiffness index &bgr; and cIMT were not related to each other (P = 0.97). Conclusion This study provides information about two markers of subclinical atherosclerosis, cIMT and carotid stiffness index &bgr;, in normal children aged 3–16 years. We found a significant age-related and height-related increase of stiffness index &bgr; in both sexes, whereas cIMT was positively related to height only in boys.

Androgenic alopecia in a postmenopausal Sicilian baroness

In the heterogeneous picture gallery, besides the magnificent “Portrait of Unknown Man”, dated between 1465 and 1476 and painted by Antonello da Messina, the greatest Sicilian Renaissance artist [1], there are portraits of the Mandralisca family, including an oil on canvas dated back to the eighteenth century and made by unknown Sicilian painter, depicting Aurora Monizio di Mandralisca, paternal grandmother of Enrico Pirajno (Fig. 1). The woman shows a clear androgenic alopecia that, considering the postmenopausal age of woman, could be caused by ovarian hyperthecosis or insulin resistance [2] or by an androgens secreting tumour such as an ovarian Leydigoma [3] or an adrenocortical adenoma [4]. Other possible causes as polycystic ovary syndrome or congenital adrenal hyperplasia are less probable due to presumably normal sexual development and the known parity [5].

L’ipertiroidismo è un fattore di rischio di trombosi venosa e arteriosa: descrizione di un caso clinico

L’incidenza dell’associazione tra ipertiroidismo e trombosi non è nota. Le alterazioni coagulative che potrebbero essere coinvolte sono: l’aumentato turnover dei fattori della coagulazione con una loro aumentata sintesi endoteliale, emofilia A acquisita, sindrome da antifosfolipidi, ridotta attività fibrinolitica, un’eccessiva attività adrenergica. Il distretto più frequentemente interessato è quello cerebrale [1]. Il paziente, maschio di 57 anni con febbre, algie addominali, tachicardia e decremento ponderale, presentava TSH 0,0 microUI/ml (0,34–4,2), FT3 19,1 pmol/L (3,8–6), FT4 68,1 pmol/L (6,8–16), leucocitosi neutrofila (GB 14.600, Ne 80%), VES 99 mm (< 14), PCR 11,4 mg/dl (< 0,5), PT 65% (80–120), PTT 41 sec (23–35), fibrinogeno 668 mg/dl (1,5–4,5). L’esame obiettivo evidenziava una tiroide aumentata di volume, dolente alla deglutizione; l’ecografia tiroidea rilevava un volume aumentato (lobo destro 35 × 32 × 53 mm, lobo sinistro 32 × 34 × 49 mm); la scintigrafia tiroidea indicava scarsa fissazione del radioiodio. Veniva trattato con paracetamolo, corticosteroidi e beta bloccante con miglioramento clinico. Dopo circa 6 giorni il paziente lamentava dolore addominale a intensità crescente, con aumento degli indici di flogosi e D-Dimero. La TAC torace e addome evidenziava malattia trombo-embolica arteriosa e venosa (Fig. 1) e il paziente veniva sottoposto a terapia trombolitica e trasferito in UTIC.

SYMPTOMATIC AND ASYMPTOMATIC CHILDREN WITH VENTRICULAR PREEXCITATION: SAME RISK FOR SUDDEN DEATH

Very recently, PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a WPW Electrocardiographic Pattern has been claimed that utilization of invasive risk stratification to assess the shortest preexcited R-R interval (SPERRI) in is reasonable in young patients