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3 results on '"Vairo U"'

1. Rapid transesophageal atrial pacing for balloon aortic valvuloplasty in neonates and infants: A new technique for balloon stabilization.

Author

Meliota G, Lombardi M, and Vairo U

Subjects
Child, Infant, Newborn, Humans, Infant, Treatment Outcome, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve Insufficiency, Atrial Fibrillation, Balloon Valvuloplasty adverse effects, Balloon Valvuloplasty methods, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery
Abstract

Balloon aortic valvuloplasty (BAV) is preferred by most centers over surgery for the treatment of congenital valve stenosis, due to its less invasive nature and faster recovery time. A variety of techniques have been employed to induce a transient cardiac standstill and reduce longitudinal balloon displacement during valve dilatation. Rapid right ventricular (RV) pacing is an effective method to stabilize the balloon during aortic valvuloplasty and it is regularly used in older children and adults. Despite the evidence of its feasibility and efficacy, its use in neonates and infants is still not widespread globally as it is associated with certain drawbacks in this population. We report the use of a new technique to achieve balloon stabilization during BAV in neonates and infants. Four patients with severe congenital aortic valve stenosis were treated with percutaneous BAV using rapid transesophageal atrial pacing. Rapid atrial pacing was performed in asynchronous modality at a rate which resulted in a drop of the systemic arterial pressure by 50%. The balloon was inflated only after the set pacing rate was reached. The pacing was continued until the balloon was completely deflated. No ventricular arrhythmia occurred. Fluoroscopy time was not influenced by transesophageal pacing. Mild aortic regurgitation developed in only one case. Rapid transesophageal atrial pacing was safe and allowed a significant relief of left ventricular obstruction while minimizing aortic regurgitation. Compared to RV pacing, it does not require additional vascular access. Moreover, transesophageal pacing is not at risk of cardiac or vascular perforation and ventricular arrhythmias., (© 2023 Wiley Periodicals LLC.)

Published
2023
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2. Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective.

Author

Brighenti M, Donti A, Giulia Gagliardi M, Maschietto N, Marini D, Lombardi M, Vairo U, Agnoletti G, Milanesi O, Pongiglione G, and Bonvicini M

Subjects
Adolescent, Age Factors, Child, Child, Preschool, Databases, Factual, Female, Humans, Incidence, Infant, Infant, Newborn, Italy epidemiology, Male, Myocarditis epidemiology, Myocarditis therapy, Predictive Value of Tests, Retrospective Studies, Risk Assessment, Risk Factors, Biopsy adverse effects, Myocarditis pathology, Myocardium pathology
Abstract

Objectives: The objective of this investigation is to evaluate the safety, the impact of endomyocardial biopsy (EMB) results in myocarditis management and the incidence of different etiologies of myocarditis in a pediatric population., Background: Although EMB is an established diagnostic tool to evaluate suspected myocarditis, there is lack of clear diagnostic and management guidelines for myocarditis in pediatric patients, particularly in infants., Methods: We performed a retrospective database review and subsequent outcomes analysis from five Italian pediatric cardiology centers to identify patients aged 0-18 years who underwent EMB for suspected myocarditis or inflammatory cardiomyopathy (ICMP) between 2009 and 2011., Results: EMB was performed in 41 children, of which 16 were male. The population ranged between 16 days of age to 17 years (mean age at EMB = 5.2 ± 4.9 years). The overall incidence of EMB-related complications was 15.5% (31.2% in infants, and 6.8% in children > 1 year of age; P = 0.079) while the incidence of EMB-driven treatment changes was 29.2%. Histological examination together with PCR on heart biopsy specimens allowed an etiological diagnosis in 26/41 patients (63%). Among the 15 patients (36.5%) with diagnosis of dilated cardiomyopathy (DCM) 11 had idiopathic DCM. Finally, we found an overall incidence of death/cardiac transplantation of 24%., Conclusions: In a pediatric population with suspected myocarditis/ICMP, EMB was useful in confirming the diagnosis only in 41% of cases but showed an overall diagnostic power of 63%. As complications of EBM are not negligible, particularly in infants, the risk/benefit ratio should be taken into account in each patient., (© 2015 Wiley Periodicals, Inc.)

Published
2016
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3. Stent strut breakage using high-pressure balloons for bifurcation stenting and subsequent percutaneous pulmonary valve replacement using the Edwards Sapien THV.

Author

Violini R, Vairo U, and Hijazi ZM

Subjects
Adult, Arterial Occlusive Diseases diagnosis, Arterial Occlusive Diseases etiology, Cineangiography, Constriction, Pathologic, Female, Heart Valve Prosthesis Implantation methods, Humans, Prosthesis Design, Pulmonary Artery diagnostic imaging, Pulmonary Valve diagnostic imaging, Pulmonary Valve Insufficiency diagnosis, Pulmonary Valve Insufficiency etiology, Tetralogy of Fallot diagnosis, Treatment Outcome, Angioplasty, Balloon instrumentation, Arterial Occlusive Diseases therapy, Cardiac Catheterization instrumentation, Cardiac Surgical Procedures adverse effects, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation instrumentation, Pulmonary Artery surgery, Pulmonary Valve surgery, Pulmonary Valve Insufficiency therapy, Stents, Tetralogy of Fallot surgery
Abstract

This report describes the use of the Edwards Sapien THV in a patient who had a short regurgitant/stenotic homograft with early bifurcation stenoses of the pulmonary arteries. A 48-mm AndraStent was positioned in the right pulmonary artery-homograft jailing the left pulmonary artery (LPA). To have an unobstructed access to the LPA, the stent strut leading to the LPA was broken using high-pressure balloon. A 23-mm Edwards Sapien THV was positioned in the stented homograft just proximal to the LPA origin with resolution of the stenosis and regurgitation., (Copyright © 2012 Wiley Periodicals, Inc.)

Published
2013
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