151 results on '"Giulia Gagliardi"'
Search Results
2. 633 THE EFFECTS OF AEROBIC EXERCISE TRAINING ON CARDIOPULMONARY EXERCISE TESTING AND HEART FAILURE BIOMARKERS IN ADULT PATIENTS WITH HYPOPLASTIC LEFT HEART SYNDROME AND FONTAN CIRCULATION
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Marco Alfonso Perrone, Elettra Pomiato, Rosalinda Palmieri, Mario Panebianco, Giulia Di Già, and Maria Giulia Gagliardi
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Cardiology and Cardiovascular Medicine - Abstract
Background Several studies have shown that adult patients with Hypoplastic Left Heart Syndrome (HLHS) and Fontan circulation have a reduced exercise tolerance that affects daily life. Recent studies have investigated the effects of aerobic exercise training in these patients with univentricular heart; however, this research topic is still poorly studied. The aim of this study was to evaluate the effects of an aerobic exercise training program on cardiopulmonary exercise testing parameters and heart failure biomarkers in patients with HLHS. Methods We enrolled 12 patients with a mean age of 24 ± 2.5 years (range 22–27 years), 50% male, with HLHS at Bambino Gesù Children's Hospital IRCCS and University of Rome Tor Vergata. All patients underwent a cardiopulmonary test and blood sampling before (T0) and after (T1) a 4-week aerobic exercise program. Cardiac biomarkers hs-cTnT, NT-proBNP, ST2, GDF-15 were studied. Results Data analysis demonstrated an increase in cardiorespiratory performance after 4 weeks of aerobic exercise training activity. In particular, the data showed a significant improvement in test duration (p < 0.05), heart rate at rest (p < 0.05), heart rate recovery 1 min (p < 0.05), VO2 max (p < 0.01) and oxygen uptake efficiency slope (p < 0.05). At the same time, the data showed a significant reduction in NT-proBNP and ST2 values (p < 0.01 and p < 0.05, respectively) and a significant increase in GDF-15 (p < 0.01). No significant changes were found between the hs-cTnT values. Conclusions Our study demonstrated the 4-week efficacy of an aerobic training program in improving cardiorespiratory performance and heart failure biomarker values in adult patients with HLHS and Fontan circulation. To the best of our knowledge this is the first study that evaluated the effects of an exercise training program in patients with univentricular heart
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- 2022
3. Repeated TACE in HCC after Fontan surgery and situs viscerum inversus: A case report
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Fabio Salimei, Antonio Orlacchio, Ilaria Lenci, Fulvio Gasparrini, Maria Giulia Gagliardi, and Marco Spada
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medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Heart disease ,TACE, trans-arterial-chemoembolization ,R895-920 ,SMA, Superior Mesenteric Artery ,Case Report ,CM, Contrast Medium ,IVC-PA, Inferior Vena Cava-Pulmonary Artery ,Chronic liver disease ,MRI, Magnetic Resonance Imaging ,ceCT, Contrast Enhanced CT ,Medical physics. Medical radiology. Nuclear medicine ,Fontan surgery ,CT, Computed Tomography, EDVi, End- Diastolic Volume index, EF, Ejection Fraction ,Settore MED/36 ,medicine ,Radiology, Nuclear Medicine and imaging ,Liver neoplasm ,SI, Situs inversus ,FALD, Fontan-associated liver disease ,bpm, beats per minute ,Cardiac cirrhosis ,Congenital heart disease ,TACE, Trans Arterial ChemoEmbolization ,business.industry ,HR, Heart Rate ,Ultrasound ,ceCT, contrast enhanced Computed Tomography ,medicine.disease ,Surgery ,Transplantation ,US, Ultrasound ,medicine.anatomical_structure ,Ventricle ,Hepatocellular carcinoma ,Liver function ,Situs viscerum inversus ,business ,HCC, hepatocellular carcinoma - Abstract
We describe the case of a 32-year-old man who developed a liver neoplasm due to previous Fontan surgery (FS) for a single ventricle anomaly and situs viscerum inversus. He was admitted to our hospital for suspected hepatocellular carcinoma during an Ultrasound (US) follow up. Computed tomography (CT) showed features of chronic liver disease and 7 cm hepatic nodule with arterial enhancement. Laboratory analyses documented preserved liver function and increased levels of alpha-fetoprotein. Trans-arterial-chemoembolization (TACE) was performed obtaining complete necrosis at 4 weeks of follow up and significant reduction of alpha-fetoprotein. The patient is currently in follow-up, being evaluated for further treatments and/or combined liver-heart transplantation. TACE is a therapeutic option for the treatment of patients with unresectable hepatocellular carcinoma (HCC) and with severe heart disease, like those submitted to FS and with also other vascular abnormalities like those correlated to situs viscerum inversus.
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- 2021
4. Distinction between SGA and FGR by means of fetal umbilical vein flow and maternal hemodynamics
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I. Pisani, D. Farsetti, Giulia Gagliardi, Herbert Valensise, Francesca Pometti, Damiano Lo Presti, Gian Paolo Novelli, Barbara Vasapollo, and G. M. Tiralongo
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Umbilical Veins ,Cardiac output ,medicine.medical_specialty ,systemic vascular resistance ,Gestational Age ,030204 cardiovascular system & hematology ,Venous flow ,Ultrasonography, Prenatal ,Umbilical vein ,small for gestational age ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,medicine ,Fetal growth ,Humans ,maternal hemodynamics ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,business.industry ,Fetal growth restriction ,Infant, Newborn ,Hemodynamics ,cardiac output ,Obstetrics and Gynecology ,medicine.disease ,umbilical vein blood flow ,medicine.anatomical_structure ,Fetal Weight ,Settore MED/40 ,Infant, Small for Gestational Age ,Pediatrics, Perinatology and Child Health ,Maternal hemodynamics ,Vascular resistance ,Cardiology ,Small for gestational age ,Female ,business - Abstract
To improve identification of fetal growth restriction (FGR) by means of umbilical venous flow (QUV) and maternal hemodynamics, including systemic vascular resistance (SVR) and cardiac output (CO), in order to distinguish between FGR and SGA.We enrolled 68 pregnancies (36 SGA, 8 early FGR and 24 late FGR) who underwent a complete fetal hemodynamic examination including QUV and a noninvasive maternal hemodynamics assessment by means of USCOM.In comparison with SGA, QUV and corrected for estimated fetal weight QUV (cQUV) were significantly lower in early and late-FGR. In addition, maternal CO was lower in early and late-FGR, while SVR was lower only in early-onset FGR. According to ROC analysis, cQUV centile (AUC 0.92, 0.72) was the best parameter for the prediction of SGA before and after 32 weeks, followed by SVR and CO. For all parameters, the prediction was always better in the case of early-onset FGR32 weeks.UV flow and maternal hemodynamics examination are useful tools to accurately discern between SGA and FGR.
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- 2021
5. Transarterial chemoembolization for hepatocellular carcinoma in Fontan surgery patient
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Antonio Orlacchio, Manlio Guazzaroni, Maria Giulia Gagliardi, Mario Angelico, Marco Spada, Giorgio Ciccarese, Ilaria Lenci, and Fulvio Gasparrini
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,Heart disease ,Hepatocellular carcinoma ,lcsh:R895-920 ,medicine.medical_treatment ,Fontan operation ,Case Report ,18F-FDG, 2-deoxy-2-[fluorine-18]fluoro- D-glucose ,Chronic liver disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Settore MED/36 ,Ascites ,medicine ,Radiology, Nuclear Medicine and imaging ,Liver neoplasm ,trans-arterial embolization ,Cardiac cirrhosis ,Congenital heart disease ,TACE, Trans Arterial ChemoEmbolization ,Heart transplantation ,US, ultrasound ,business.industry ,PET-CT, positron emission tomography ,ceCT, contrast enhanced Computed Tomography ,medicine.disease ,DSA, Digital Subtraction Angiography ,Surgery ,medicine.anatomical_structure ,Ventricle ,Liver function ,medicine.symptom ,business ,HCC, hepatocellular carcinoma ,030217 neurology & neurosurgery - Abstract
We describe the case of a 41‐year‐old woman who developed a liver neoplasm due to previous Fontan surgery for a single ventricle anomaly and pacemaker implantation. She was admitted to our hospital for moderate ascites and she was affected by hepatocellular carcinoma treated by trans-arterial chemoembolization (TACE). Computed tomography showed features of chronic liver disease and 4 cm hepatic nodules with arterial enhancement. Laboratory analyses documented preserved liver function and increased levels of alpha-fetoprotein. TACE was performed obtaining complete necrosis at 4 weeks of follow up and significant reduction of alpha-fetoprotein after 2 months. The patient is currently in follow-up, being evaluated for further treatments and/or combined liver/heart transplantation. TACE is a therapeutic option for the treatment of patients with unresectable HCC and with severe heart disease, like those submitted to FS.
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- 2020
6. Hemodynamic maladaptation and left ventricular dysfunction in chronic hypertensive patients at the beginning of gestation and pregnancy complications: a case control study
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Herbert Valensise, Gian Paolo Novelli, I. Pisani, Giulia Gagliardi, G. M. Tiralongo, D. Farsetti, Barbara Vasapollo, and Damiano Lo Presti
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medicine.medical_specialty ,Hemodynamics ,Early pregnancy factor ,left ventricular function ,Ventricular Dysfunction, Left ,Pregnancy ,Internal medicine ,medicine ,Humans ,Maladaptation ,Cardiac geometry ,biology ,business.industry ,Case-control study ,Obstetrics and Gynecology ,medicine.disease ,Chronic hypertension ,left ventricular geometry ,Settore MED/40 ,Echocardiography ,Case-Control Studies ,Hypertension ,Pediatrics, Perinatology and Child Health ,Maternal hemodynamics ,biology.protein ,Cardiology ,Gestation ,Female ,business - Abstract
The aim of this study was to evaluate early pregnancy differences in maternal hemodynamics, cardiac geometry and function, between chronic hypertensive (CH) patients with and without the development of feto-maternal complications later in pregnancy.We performed a case-control study on nulliparous CH treated patients. From a group of CH patients referred to our outpatient clinic at 4-6 weeks for a clinical evaluation the first consecutive 30 patients with subsequent complications (superimposed PE, abruptio placentae, uncontrolled severe hypertension with delivery34 weeks, HELLP syndrome, FGR, perinatal death) were enrolled; the first 2 CH women with uneventful pregnancy referred after the case were enrolled as controls for a total of 60 patients. All patients were shifted to alpha-methyl dopa at the beginning of pregnancy and were submitted to an echocardiographic evaluation to assess the maternal hemodynamics, cardiac geometry, diastolic and systolic function.Patients developing complications had a lower early pregnancy heart rate (73 ± 11 vs. 82 ± 11 bpm), cardiac output (5.23 ± 1.2 vs. 6.5 ± 1.3 L/min,CH treated patients developing maternal and/or fetal complications show early pregnancy altered cardiac geometry, diastolic and systolic dysfunction, and impaired hemodynamics with a high resistance circulation.
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- 2020
7. Left ventricular unloading during extracorporeal membrane oxygenation – Impella versus atrial septal defect: A simulation study
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Athar M. Qureshi, Matteo Di Molfetta, Gianfranco Ferrari, Giovanni Alfonso Chiariello, G. Perri, Luigi Di Pasquale, Paolo Guccione, Sergio Filippelli, Maria Giulia Gagliardi, Rodrigo Zea Vera, Arianna Di Molfetta, Roberta Iacobelli, Antonio Amodeo, and Iki Adachi
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medicine.medical_specialty ,Heart Ventricles ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,030204 cardiovascular system & hematology ,Heart Septal Defects, Atrial ,Biomaterials ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Computer Simulation ,Heart Atria ,cardiovascular diseases ,Impella ,business.industry ,Hemodynamics ,Models, Cardiovascular ,General Medicine ,030228 respiratory system ,Echocardiography ,cardiovascular system ,Cardiology ,business - Abstract
Background: Atrial septal defect and Impella have been proposed for left ventricular unloading in venoarterial extracorporeal membrane oxygenation patients. This work aims at evaluating the haemodynamic changes in venoarterial extracorporeal membrane oxygenation patients after Impella implantation or atrial septal defect realization by a simulation study. Methods: A lumped parameter model of the cardiovascular system was adapted to this study. Atrial septal defect was modelled as a resistance between the two atria. Venoarterial extracorporeal membrane oxygenation and Impella were modelled starting from their pressure-flow characteristics. The baseline condition of a patient undergoing venoarterial extracorporeal membrane oxygenation was reproduced starting from haemodynamic and echocardiographic data. The effects of different atrial septal defect size, Impella and venoarterial extracorporeal membrane oxygenation support were simulated. Results: Impella caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary arterial pressure up to 8%, a decrement in left ventricular end systolic volume up to 11% with a reduction up to 97% of left ventricular cardiac output. Atrial septal defect reduces left atrial pressure (19%), increases right atrial pressure (22%), increases mean arterial pressure (18%), decreases left ventricular end systolic volume (11%), increases right ventricular volume (33%) and decreases left ventricular cardiac output (55%). Conclusion: Impella has a higher capability in left ventricular unloading during venoarterial extracorporeal membrane oxygenation in comparison to atrial septal defect with a lower right ventricular overload.
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- 2020
8. Cardiopulmonary Exercise Testing in Repaired Tetralogy of Fallot: Multiparametric Overview and Correlation with Cardiac Magnetic Resonance and Physical Activity Level
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Benedetta Leonardi, Federica Gentili, Marco Alfonso Perrone, Fabrizio Sollazzo, Lucia Cocomello, Stefani Silva Kikina, Rachel M. Wald, Vincenzo Palmieri, Aurelio Secinaro, Maria Giulia Gagliardi, Attilio Parisi, Attilio Turchetta, Lorenzo Galletti, Massimiliano Bianco, and Fabrizio Drago
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physical activity ,tetralogy of Fallot ,cardiopulmonary exercise testing ,cardiac magnetic resonance ,exercise capacity ,pulmonary valve ,Article ,Settore M-EDF/01 - METODI E DIDATTICHE DELLE ATTIVITÀ MOTORIE ,RC666-701 ,LS ,Diseases of the circulatory (Cardiovascular) system ,Pharmacology (medical) ,General Pharmacology, Toxicology and Pharmaceutics - Abstract
Patients with repaired Tetralogy of Fallot (rToF) typically report having preserved subjective exercise tolerance. Chronic pulmonary regurgitation (PR) with varying degrees of right ventricular (RV) dilation as assessed by cardiac magnetic resonance imaging (MRI) is prevalent in rToF and may contribute to clinical compromise. Cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capacity, and the International Physical Activity Questionnaire (IPAQ) can provide additional data on physical activity (PA) achieved. Our aim was to assess the association between CPET values, IPAQ measures, and MRI parameters. All rToF patients who had both an MRI and CPET performed within one year between March 2019 and June 2021 were selected. Clinical data were extracted from electronic records (including demographic, surgical history, New York Heart Association (NYHA) functional class, QRS duration, arrhythmia, MRI parameters, and CPET data). PA level, based on the IPAQ, was assessed at the time of CPET. Eighty-four patients (22.8 ± 8.4 years) showed a reduction in exercise capacity (median peak VO2 30 mL/kg/min (range 25–33); median percent predicted peak VO2 68% (range 61–78)). Peak VO2, correlated with biventricular stroke volumes (RVSV: β = 6.11 (95%CI, 2.38 to 9.85), p = 0.002; LVSV: β = 15.69 (95% CI 10.16 to 21.21), p < 0.0001) and LVEDVi (β = 8.74 (95%CI, 0.66 to 16.83), p = 0.04) on multivariate analysis adjusted for age, gender, and PA level. Other parameters which correlated with stroke volumes included oxygen uptake efficiency slope (OUES) (RVSV: β = 6.88 (95%CI, 1.93 to 11.84), p = 0.008; LVSV: β = 17.86 (95% CI 10.31 to 25.42), p < 0.0001) and peak O2 pulse (RVSV: β = 0.03 (95%CI, 0.01 to 0.05), p = 0.007; LVSV: β = 0.08 (95% CI 0.05 to 0.11), p < 0.0001). On multivariate analysis adjusted for age and gender, PA level correlated significantly with peak VO2/kg (β = 0.02, 95% CI 0.003 to 0.04; p = 0.019). We observed a reduction in objective exercise tolerance in rToF patients. Biventricular stroke volumes and LVEDVi were associated with peak VO2 irrespective of RV size. OUES and peak O2 pulse were also associated with biventricular stroke volumes. While PA level was associated with peak VO2, the incremental value of this parameter should be the focus of future studies.
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- 2022
9. 789 Cardiopulmonary exercise testing in repaired tetralogy of Fallot patients: correlation with the level of physical activity and cardiac magnetic resonance imaging
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Marco Alfonso Perrone, Federica Gentili, Davide Curione, Paolo Ciancarella, Aurelio Secinaro, Maria Giulia Gagliardi, Attilio Turchetta, Paolo Guccione, Lorenzo Galletti, Massimiliano Bianco, Fabrizio Drago, and Benedetta Leonardi
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Cardiology and Cardiovascular Medicine - Abstract
Aims Patients with repaired Tetralogy of Fallot (rToF) tend to have a decent life free of limitations. In asymptomatic individuals, cardiac magnetic resonance imaging (MRI) is used to determine if pulmonary valve replacement (PVR) is necessary. Cardiopulmonary exercise testing (CPET) could aid in determining the extent of functional impairment. Methods and results rToF patients who had an MRI and CPET between 2019 and 2021 in a brief interval ( Conclusion In rToF patients with moderate–severe PR, NYHA class I, preserved RVEF, a slight reduction in exercise tolerance was detected. OUES could also be valuable to this population. A positive association was found between RV dilation and exercise performance up to 160 ml/m2 of RVEDVi, suggesting that perhaps at this cut-off value of RVEDVi, PVR could start being considered.
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- 2021
10. SARS-CoV-2 and Pre-Tamponade Pericardial Effusion. Could Sotos Syndrome Be a Major Risk Factor?
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Barbara Citoni, Andrea Campana, Fabrizio Drago, Maria Giulia Gagliardi, Maria Cristina Digilio, Giulio Calcagni, and Rossella Capolino
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Pediatrics ,medicine.medical_specialty ,Genetic syndromes ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,viruses ,Case Report ,QH426-470 ,Genetic Condition ,Pericardial effusion ,pericarditis ,Pericarditis ,medicine ,Genetics ,Risk factor ,skin and connective tissue diseases ,Sotos syndrome ,Genetics (clinical) ,business.industry ,SARS-CoV-2 ,fungi ,COVID-19 ,medicine.disease ,pericardial effusion ,respiratory tract diseases ,body regions ,Tamponade ,business - Abstract
Pericarditis with pericardial effusion in SARS CoV-2 infection is a well-known entity in adults. In children and adolescents, only a few cases have been reported. Here, we present here a case of a 15-year-old girl affected by Sotos syndrome with pre-tamponed pericardial effusion occurred during SARS-CoV-2 infection. A possible relation between SARS-CoV-2 pericarditis and genetic syndromes, as a major risk factor for the development of severe inflammation, has been speculated. We emphasize the importance of active surveillance by echocardiograms when SARS-CoV-2 infection occurs in combination with a genetic condition.
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- 2021
11. Left ventricle dysfunction in patients with critical neonatal pulmonary stenosis: echocardiographic predictors. A single-center retrospective study
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Carolina D’Anna, Alessio Franceschini, Micol Rebonato, Paolo Ciliberti, Claudia Esposito, Roberto Formigari, Maria Giulia Gagliardi, Paolo Guccione, Gianfranco Butera, Lorenzo Galletti, and Marcello Chinali
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Male ,Heart Defects, Congenital ,Cardiac Catheterization ,Heart Ventricles ,General Neuroscience ,Infant, Newborn ,Infant ,General Medicine ,Pulmonary Valve Insufficiency ,General Biochemistry, Genetics and Molecular Biology ,Pulmonary Valve Stenosis ,Ventricular Dysfunction, Left ,Treatment Outcome ,Pulmonary Atresia ,Echocardiography ,Humans ,Female ,Child ,Cardiomyopathies ,General Agricultural and Biological Sciences ,Retrospective Studies - Abstract
Background The aim of this study is to identify echocardiographic predictors of transient left ventricle dysfunction after pulmonary valve balloon dilatation (PVBD), in neonates with pulmonary valve stenosis (PVS) and atresia with intact septum (PAIVS) at birth. Methods The study includes patients admitted at the Bambino Gesù Children Hospital from January 2012 to January 2017. Clinical, echocardiographic and cardiac catheterization data before and after PVBD were retrospectively analyzed. Results Twenty-nine infants were included in the study (21 male and eight female). The median age was 5.8 ± 7.1 days. Eight patients developed transient LV dysfunction (three PAIVS and five PVS) and comparing data before and after the procedure, there was no difference in right ventricle geometrical and functional parameters except for evidence of at least moderate pulmonary valve regurgitation after PVBD. Conclusion Moderate to severe degree pulmonary valve regurgitation was significant associated to LV dysfunction (p < 0.05) in PVS and PAIVS patients.
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- 2022
12. Risk Factors of Right Ventricular Dysfunction and Adverse Cardiac Events in Patients with Repaired Tetralogy of Fallot
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Benedetta Leonardi, Adriano Carotti, Aurelio Secinaro, Marco A Perrone, Paolo Guccione, Lorenzo Galletti, Maria Giulia Gagliardi, Arianna Di Rocco, Sonia B. Albanese, Davide Curione, Camilla Calvieri, Massimo Caputo, and Fabrizio Drago
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Ventricular Dysfunction, Right ,Health, Toxicology and Mutagenesis ,cardiac magnetic resonance imaging ,Article ,Young Adult ,pulmonary valve ,Risk Factors ,Cardiac magnetic resonance imaging ,right ventricle dysfunction ,Pulmonary Valve Replacement ,Internal medicine ,medicine ,Humans ,In patient ,Young adult ,Tetralogy of Fallot ,Heart Valve Prosthesis Implantation ,Ventricular Dysfunction, Right/epidemiology ,medicine.diagnostic_test ,business.industry ,Public Health, Environmental and Occupational Health ,Transventricular ,Infant ,Magnetic resonance imaging ,Pulmonary Valve Insufficiency/diagnostic imaging ,medicine.disease ,Tetralogy of Fallot/epidemiology ,repaired Tetralogy of Fallot ,Pulmonary Valve Insufficiency ,Treatment Outcome ,medicine.anatomical_structure ,Pulmonary valve ,Ventricular Function, Right ,Cardiology ,Medicine ,Female ,business - Abstract
AIM: This study evaluates the risk factors associated with right ventricular (RV) dilation and dysfunction leading to pulmonary valve replacement (PVR) or adverse cardiac events in repaired Tetralogy of Fallot (rToF) patients.METHODS: Data from all rToF patients who underwent magnetic resonance imaging (MRI) evaluation at our hospital between February 2007 and September 2020 were collected.RESULTS: Three hundred and forty-two patients (60% males, 42% older than 18 years), with a median age of 16 years (IQR 13-24) at the time of MRI, were included. All patients underwent complete repair at a median age of 8 months (IQR 5-16), while palliation was performed in 56 patients (16%). One hundred and forty-four patients (42%) subsequently received pulmonary valve replacement (PVR). At the multivariate analysis, male gender was an independent predictor for significant RV dilation, RV and left ventricular (LV) dysfunction. Transventricular ventricular septal defect (VSD) closure and previous palliation significantly affected LV function and RV size, respectively. Male gender and the transventricular VSD closure were independent predictors for PVR.CONCLUSIONS: Male gender and surgical history (palliation, VSD closure approach) significantly affected the long-term outcomes in rToF patients and should be taken into consideration in the follow-up management and in PVR timing in this patient population.
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- 2021
13. Predicting the pressure of the total cavopulmonary connection: clinical testing of a mathematical equation
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Roberta Iacobelli, Paolo Guccione, Roberto Formigari, Salvatore F Iorio, Maria Giulia Gagliardi, Silvia Rotella, Luciano Pasquini, Arianna Di Molfetta, and Antonio Amodeo
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Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Total cavopulmonary connection ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Fontan Procedure ,Retrospective data ,03 medical and health sciences ,0302 clinical medicine ,Mathematical equations ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Poor correlation ,Retrospective Studies ,business.industry ,Heart Bypass, Right ,Hemodynamics ,Cavopulmonary Anastomosis ,General Medicine ,Predictive value ,Treatment Outcome ,Multiple factors ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Linear Models ,Cardiology ,Female ,Venae Cavae ,Cardiology and Cardiovascular Medicine ,Fenestration ,business - Abstract
Introduction:Some authors advocate the use of a dedicated formula to predict the Fontan pressure starting from pre-Fontan catheterisation data. This paper aims at testing the predictive value of the mentioned formula through a retrospective clinical study.Methods and Results:Pre-Fontan catheterisation data and Fontan pressure measured at the completion were retrospectively collected. Pre-Fontan data were used to calculate the predicted pressure in the Fontan system. The predicted values were compared to the Fontan pressure measured at the Fontan completion and with the needs for fenestration. One hundred twenty-four Fontan patients were retrospectively enrolled (At Fontan: median age 30.73 [24.70–37.20] months, median weight 12.00 [10.98–14.15] kg). Fontan conduit was fenestrated in 78 patients. A poor correlation (r2= 0.05128) between the measured and predicted data for non-fenestrated patients was observed. In the case of Fontan-predicted pressure Conclusion:The proposed formula showed a poor capability in estimating the actual pressure into the Fontan system and in identifying patients needing fenestration. As the pressure into the Fontan system is determined by multiple factors, the tested formula could be an additional data in a multi-parametric approach.
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- 2019
14. Pediatric Myocarditis: What Have We Learnt So Far?
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Elettra Pomiato, Marco Alfonso Perrone, Rosalinda Palmieri, and Maria Giulia Gagliardi
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Pharmacology (medical) ,General Pharmacology, Toxicology and Pharmaceutics - Abstract
Myocarditis is an inflammatory disease of the myocardium that is troublesome to diagnose and manage, especially in children. Since the introduction of endomyocardial biopsy (EMB), new diagnostic tools have provided useful data. Especially when enhanced with immunohistochemistry and polymerase chain reaction (PCR) studies, EMB remains the gold standard for the diagnosis. Notably, cardiac magnetic resonance (MRI) is a non-invasive tool that can confirm the diagnosis and has a particular usefulness during the follow-up. The causes of myocarditis are heterogeneous (mostly viral in children). The course and outcome of the illness in the pediatric population represent a complex interaction between etiologic agents and the immune system, which is still not fully understood. The clinical presentation and course of myocarditis vary widely from paucisymptomatic illness to acute heart failure refractory to therapy, arrhythmias, angina-like presentation and sudden cardiac death. In this setting, cardiac biomarkers (i.e., troponins and BNP), although unspecific, can be used to support the diagnosis. Finally, the efficacy of therapeutic strategies is controversial and not confirmed by clinical trials. In this review, we summarized the milestones in diagnosis and provided an overview of the therapeutic options for myocarditis in children.
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- 2022
15. Fetal Umbilical Vein Flow in the Classification of Fetuses with Growth Restriction
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Gian Paolo Novelli, Giulia Gagliardi, G. M. Tiralongo, D. Farsetti, Francesca Pometti, Herbert Valensise, Barbara Vasapollo, Damiano Lo Presti, and I. Pisani
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medicine.medical_specialty ,Ocean Engineering ,030204 cardiovascular system & hematology ,early-FGR ,Umbilical vein ,fetal growth restriction ,late-FGR ,03 medical and health sciences ,small for gestational age ,0302 clinical medicine ,Growth restriction ,medicine ,reproductive and urinary physiology ,Water Science and Technology ,Fetus ,Pregnancy ,030219 obstetrics & reproductive medicine ,Receiver operating characteristic ,Obstetrics ,business.industry ,Fetal doppler ,Geology ,Blood flow ,medicine.disease ,umbilical vein blood flow ,female genital diseases and pregnancy complications ,Settore MED/40 ,Small for gestational age ,business - Abstract
Objectives: To assess umbilical vein (UV) blood flow in fetal growth restriction (FGR) and in pregnancy with small for gestational age (SGA) fetus. To evaluate the predictive capacity of UV blood flow (QUV) in the discrimination of SGA fetuses from FGR before and after 32 weeks of pregnancy. Methods: Sixty-five women with a recent diagnosis of FGR or SGA fetuses were enrolled and underwent a complete fetal Doppler examination comprehending QUV. We collected SGA (n = 34), early-FGR (n = 9), and late-FGR (n = 22) fetuses. Results: UV diameter was lower in early and late-FGR compared to SGA, while time-averaged maximum velocity (TAMXV) was lower only in early-FGR. UV blood flow (QUV) and QUV corrected for estimated fetal weight (cQUV) were significantly lower in early-FGR and late-FGR compared to SGA. The receiver operating characteristic (ROC) curves analysis of cQUV showed a significant predictive capacity for SGA diagnosis before and after 32 weeks. Conclusions: The evaluation of UV blood flow allows distinguishing SGA fetuses from FGR. The assessment of UV flow should be taken into consideration in future research of new parameters to differentiate SGA from FGR.
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- 2021
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16. PRODUÇÃO DE CERVEJAS ÁCIDAS COM MICRORGANISMOS NÃO CONVENCIONAIS
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Handray Fernandes de Souza, Giulia Gagliardi Stramandinoli, Katrin Stefani Koch, Victoria Mariano Dobra, Rafael Resende Maldonado, Eliana Setsuko Kamimura, and Mariana Fronja Carosia
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- 2021
17. [The management of adult congenital heart disease in the emergency department. The Task Force from the Italian Society of Pediatric Cardiology and Congenital Heart Disease]
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Rosaria, Barracano, Rosalinda, Palmieri, Massimo, Chessa, Laurenzia, Ferraris, Berardo, Sarubbi, Michele, D'Alto, Gabriele, Egidy Assenza, Andrea, Donti, and Maria Giulia, Gagliardi
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Adult ,Heart Defects, Congenital ,Italy ,Cardiology ,Humans ,Arrhythmias, Cardiac ,Child ,Emergency Service, Hospital - Abstract
Over recent years, thanks to remarkable advances in pediatric cardiology, cardiac surgery and catheter interventions, survival of children with congenital heart disease has significantly increased with the majority of patients surviving into adulthood. Therefore, the prevalence of adult patients with congenital heart disease has dramatically increased, as well as the need for specific and dedicated programs. Acute heart failure, infective endocarditis and arrhythmias represent the most common causes of visit in the emergency department in this population. Our task force aimed at guiding physicians taking care of this peculiar cohort of patients in the emergency department.
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- 2021
18. Hemodynamics in Pericardial and Myocardial Diseases
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Maria Giulia Gagliardi, Mario Panebianco, Roberto Formigari, and Giacomo Pongiglione
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- 2021
19. Heart involvement in type 1 and type 2 myotonic dystrophy. Insights from a 10-year follow-up study
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F Fioravanti, I Ferraro, S Mazzilli, Marzia Colopi, Marco Carbone, G M De Ferrari, Davide Castagno, Maria Giulia Gagliardi, A Panarelli, P. G. Golzio, and Carla Giustetto
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Supraventricular arrhythmia ,medicine.medical_specialty ,Ejection fraction ,business.industry ,10 year follow up ,Holter Electrocardiography ,Cardiac arrhythmia ,medicine.disease ,Myotonic dystrophy ,Device implant ,Internal medicine ,Cardiology ,Medicine ,Echocardiography transthoracic ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and aim Myotonic Dystrophy (MD) is the most common inherited muscular dystrophy of the adult. Cardiac manifestation, including arrhythmias and conduction disorders, contributes significantly to the morbidity and mortality of the disease. The transition from a subclinical form of cardiac involvement to potentially life-threating manifestations is highly variable and not yet entirely understood. Aim of this work is to evaluate whether PQ interval (PQi) prolongation could be a reliable marker to predict left and right ventricle impairment and the necessity of a stricter monitoring. Methods In this retrospective cohort study, we selected all consecutive patients with a confirmed diagnosis of MD (type 1 and type 2) referred to our Centre. We performed clinical, laboratoristic and instrumental assessments (every 3, 6 or 12 months), tailored on each patient's features. Every patient was treated according to the latest guidelines for pharmacological and device therapy. ECG (recorded at 25 and 50 mm/sec), 24h ECG Holter and transthoracic echocardiography were performed at least yearly. Cardiac Magnetic Resonance was requested to better stratify intermediate risk patients to implantable device therapy. Results A total of 72 patients (age 48±15 years, 39% female) were included in the analysis. Patients with MD type 1 and type 2 were referred to our Centre after a mean period of 12 years (SD ±8 years) from initial diagnosis. After a mean follow-up of 5 years (±4 years), 8 patients died (mean age at death: 60±12.4 years), all of them for respiratory insufficiency. We evaluated PQ interval (PQi) evolution and type I AVB onset. No statistically significant differences emerged when stratifying for type I AVB. Nevertheless, a PQi increase of more than 20 ms during the follow-up (even if PQ Conclusions Although relatively rare, MD is a challenge for present Cardiologists. How and when to treat those patients is not codified in guidelines or consensus papers. This study suggests PQi variation as a proxy for critical evolution of MD cardiac involvement. ECG and its modification during lifetime seem pivotal for these patients' care, qualifying as a red flag for stringent follow-up. Further evidences, on larger cohorts, are needed to validate these findings. Funding Acknowledgement Type of funding source: None
- Published
- 2020
20. Syndromic and Non-Syndromic Patients with Repaired Tetralogy of Fallot: Does It Affect the Long-Term Outcome?
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Giulio Calcagni, Camilla Calvieri, Anwar Baban, Francesco Bianco, Rosaria Barracano, Massimo Caputo, Andrea Madrigali, Stefani Silva Kikina, Marco Alfonso Perrone, Maria Cristina Digilio, Marco Pozzi, Aurelio Secinaro, Berardo Sarubbi, Lorenzo Galletti, Maria Giulia Gagliardi, Andrea de Zorzi, Fabrizio Drago, and Benedetta Leonardi
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genetic syndromes ,Tetralogy of Fallot (ToF) ,congenital heart disease (CHD) ,cardiac magnetic resonance imaging (cMRI) ,pulmonary valve replacement (PVR) ,Medicine ,General Medicine - Abstract
Background: The impact of genetic syndromes on cardiac magnetic resonance imaging (cMRI) parameters, particularly on right and/or left ventricular dysfunction, associated with clinical parameters following the repair of Tetralogy of Fallot (rToF) is not well known. Therefore, this study aimed to assess the differences in clinical, surgical, and cMRI data in syndromic and non-syndromic rToF patients. Methods: All syndromic rToF patients undergoing a cMRI without general anesthesia between 2010 and 2020 who were able to match with non-syndromic ones for birth date, sex, type of surgery, timing of cMRI, and BSA were selected. Demographic, clinical, surgical, MRI, ECG, and Holter ECG data were collected. Results: A total of one hundred and eight rToF patients equally subdivided into syndromic and non-syndromic, aged 18.7 ± 7.3 years, were studied. Del22q11.2 and Down syndrome (DS) were the most frequent syndromes (42.6% and 31.5%, respectively). Regarding the cMRI parameters considered, left ventricular (LV) dysfunction (LVEF < 50%) was more frequently found in syndromic patients (p = 0.040). In addition, they were older at repair (p = 0.002) but underwent earlier pulmonary valve replacement (PVR) (15.9 ± 5.6 vs. 19.5 ± 6.0 years, p = 0.049). On multivariate Cox regression analysis, adjusted for age at first repair, LV dysfunction remained significantly more associated with DS than del22q11.2 and non-syndromic patients (HR of 5.245; 95% CI 1.709–16.100, p = 0.004). There were only four episodes of non-sustained ventricular tachycardia in our cohort. Conclusions: Among the cMRI parameters commonly taken into consideration in rToF patients, LV dysfunction seemed to be the only one affected by the presence of a genetic syndrome. The percentage of patients performing PVR appears to be similar in both populations, although syndromic patients were older at repair and younger at PVR. Finally, the number of arrhythmic events in rToF patients seems to be low and unaffected by chromosomal abnormalities.
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- 2022
21. The relevance of maternal cardiovascular situation before labor in the outcome of birth: an observational study
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Daniele Farsetti, Grazia Tiralongo, Ilaria Pisani, Damiano Lo Presti, Giulia Gagliardi, Barbara Vasapollo, Gian Paolo Novelli, and Herbert Valensise
- Published
- 2020
22. Pregnancy complications in chronic hypertensive patients are linked to pre-pregnancy maternal cardiac function and structure
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Gian Paolo Novelli, D. Farsetti, Giulia Gagliardi, Barbara Vasapollo, and Herbert Valensise
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Cardiac function curve ,Adult ,medicine.medical_specialty ,Mean arterial pressure ,Cardiac output ,Complications of pregnancy ,Heart Ventricles ,Diastole ,Cohort Studies ,Ventricular Dysfunction, Left ,Pregnancy ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Univariate analysis ,business.industry ,Obstetrics and Gynecology ,Prenatal Care ,Hypertension, Pregnancy-Induced ,medicine.disease ,medicine.anatomical_structure ,ROC Curve ,Settore MED/40 ,Echocardiography ,Hypertension ,Vascular resistance ,Cardiology ,Female ,business - Abstract
Chronic hypertension complicates around 3% of all pregnancies and is associated with an increased risk for pregnancy complications such as superimposed preeclampsia, fetal growth restriction, preterm delivery, and stillbirth, reaching a rate of complications of up to 25-28%.We performed an echocardiographic study to evaluate pre-pregnancy cardiac geometry and function, along with the hemodynamic features of treated chronic hypertension patients, searching for a possible correlation with the development of feto-maternal complications and with pre-pregnancy therapy.This was a prospective observational cohort study of 192 consecutive patients receiving treatment for chronic hypertension (calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, α1-adrenoceptor antagonists, and/or diuretics). Patients underwent echocardiography before pregnancy, assessing left ventricular morphology and function, cardiac output, and total vascular resistance. Pre-pregnancy therapy was noted, patients were shifted to α-methyldopa right before pregnancy, and were followed until delivery, noting major early (34weeks' gestation) and late (≥34 weeks' gestation) complications. Comparisons among the 3 groups (ie, those with no complications, early complications, and late complications) were performed with 1-way analysis of variance with Student-Newman-Keuls correction for multiple comparisons. The Mann-Whitney U test was used for non-normally distributed data. Comparison of proportions was used as appropriate. Receiver operating characteristic curve analysis was used to identify cutoff values of diastolic dysfunction in this population using the E/e' ratio, and separate cutoff of values for total vascular resistance for the prediction of early and late complications of pregnancy. Binary univariate and multivariate logistic regression as well as Cox proportional hazards regression were used to evaluate the possible correlation among angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and/or calcium channel blocker pre-pregnancy therapy, cardiovascular features, and the risk for subsequent early and late complications of pregnancy.Of 192 patients, 141 had no complications, and 51 had a complicated pregnancy (24 had early complications and 27 had late complications). Concentric geometry was more frequent in those women with early versus late and no complications (50% vs 13.5% and 11.1%, respectively; P.05), whereas eccentric hypertrophy was more represented in women with late versus early and no complications (32% versus 12.5% and 1.4%, respectively; P.05). The receiver operating characteristic curve showed an E/e' ratio value7.65 (sensitivity, 59.6%; specificity, 68.6%) as a predictor of subsequent complications of pregnancy, whereas total vascular resistance1048 (sensitivity, 83.7%; specificity, 55.6%) was predictive for late complications and total vascular resistance1498 (sensitivity, 87.5%; specificity, 78.0%) for the early complications of pregnancy. Univariate analysis showed that the following parameters were predictive for complications of pregnancy: altered geometry of the left ventricle (odds ratio, 5.94; 95% confidence interval, 2.90-12.19), diastolic dysfunction (odds ratio, 3.22; 95% confidence interval, 1.63-6.37), altered total vascular resistance (odds ratio, 3.52; 95% confidence interval, 1.78-6.97), and pre-pregnancy therapy without calcium channel blockers/angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (odds ratio, 2.73; 95% confidence interval, 1.37-5.42). These parameters, except for altered total vascular resistance, were independent predictors in the multivariate analysis corrected for body mass index, heart rate, parity, and mean arterial pressure.Chronic hypertension patients with pre-pregnancy cardiac remodeling and dysfunction more often develop early and late complications of pregnancy. Pre-pregnancy therapy for chronic hypertension patients with calcium channel blockers and/or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers may positively influence cardiac profiles and the outcome of a future pregnancy with a reduced rate of complications.
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- 2019
23. Restricted physical activity in pregnancy reduces maternal vascular resistance and improves fetal growth
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D. Farsetti, D. Lo Presti, Barbara Vasapollo, Herbert Valensise, Gian Paolo Novelli, Giulia Gagliardi, I. Pisani, and G. M. Tiralongo
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,business.industry ,Restricted physical activity ,medicine.medical_treatment ,Abdominal circumference ,Obstetrics and Gynecology ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Bed rest ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Blood pressure ,Reproductive Medicine ,medicine ,Fetal growth ,Vascular resistance ,Gestation ,Radiology, Nuclear Medicine and imaging ,business - Abstract
OBJECTIVES To test the efficacy of maternal activity restriction for reducing peripheral vascular resistance in normotensive pregnant women with raised total vascular resistance (TVR) and to evaluate its effect on fetal growth. METHODS This was a prospective case-control study of 30 women enrolled between 27 and 29 weeks' gestation. All patients met the following criteria: normal blood pressure before and during pregnancy, TVR between 1300 and 1400 dynes × s/cm5 at enrolment, normal fetal Doppler parameters at enrolment and abdominal circumference between the 10th and 25th centiles. Patients were assigned to activity restriction (activity-restriction group; n = 15) or no treatment (control group; n = 15) and were assessed after 4 weeks for TVR and fetal growth. RESULTS TVR at enrolment and estimated fetal weight centile were similar in the activity-restriction group vs controls (1358 ± 26 vs 1353 ± 30 dynes × s/cm5 ; 18th ± 4 vs 19th ± 4 centile; P = NS). After 4 weeks, the activity-restriction group compared with controls showed significantly lower TVR (1165 ± 159 vs 1314 ± 190 dynes × s/cm5 ; P
- Published
- 2018
24. Maternal hemodynamics early in labor: a possible link with obstetric risk?
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Herbert Valensise, D. Lo Presti, Gian Paolo Novelli, I. Pisani, G. M. Tiralongo, M. R. Basile, Giulia Gagliardi, Barbara Vasapollo, and D. Farsetti
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medicine.medical_specialty ,Pregnancy ,Cardiac output ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Cardiac index ,Obstetrics and Gynecology ,Hemodynamics ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Labor Complication ,Uterine atony ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Reproductive Medicine ,Vascular resistance ,Fetal distress ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
Objective To determine if hemodynamic assessment in 'low-risk' pregnant women at term with an appropriate-for-gestational age (AGA) fetus can improve the identification of patients who will suffer maternal or fetal/neonatal complications during labor. Methods This was a prospective observational study of 77 women with low-risk term pregnancy and AGA fetus, in the early stages of labor. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor (USCOM® ) system. Patients were followed until the end of labor to identify fetal/neonatal and maternal outcomes, and those which developed complications of labor were compared with those delivering without complications. Results Eleven (14.3%) patients had a complication during labor: in seven there was fetal distress and in four there were maternal complications (postpartum hemorrhage and/or uterine atony). Patients who developed complications during labor had lower cardiac output (5.6 ± 1.0 vs 6.7 ± 1.3 L/min, P = 0.01) and cardiac index (3.1 ± 0.6 vs 3.5 ± 0.7 L/min/m2 , P = 0.04), and higher total vascular resistance (1195.3 ± 205.3 vs 1017.8 ± 225.6 dynes × s/cm5 , P = 0.017) early in labor, compared with those who did not develop complications. Receiver-operating characteristics curve analysis to determine cut-offs showed cardiac output ≤ 5.8 L/min (sensitivity, 81.8%; specificity, 69.7%), cardiac index ≤ 2.9 L/min/m2 (sensitivity, 63.6%; specificity, 76.9%) and total vascular resistance > 1069 dynes × s/cm5 (sensitivity, 81.8%; specificity, 63.6%) to best predict maternal or fetal/neonatal complications. Conclusions The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during labor. In particular, low cardiac output and high total vascular resistance are apparently associated with higher risk of fetal distress or maternal complications. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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- 2018
25. Correlation between maternal body composition and haemodynamic changes in pregnancy: different profiles for different hypertensive disorders
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D. Lo Presti, D. Farsetti, I. Pisani, Barbara Vasapollo, Gian Paolo Novelli, Angela Andreoli, G. M. Tiralongo, Giulia Gagliardi, and Herbert Valensise
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Adult ,Gestational hypertension ,Cardiac function curve ,medicine.medical_specialty ,Cardiac output ,Body water ,Population ,030204 cardiovascular system & hematology ,Pregnancy-Induced ,Maternal body composition ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Settore MED/30 ,Prenatal Diagnosis ,Electric Impedance ,Internal Medicine ,medicine ,Hypertensive pregnancy disorders ,Humans ,Cardiac Output ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Haemodynamics in pregnancy ,Total vascular resistance ,Female ,Hypertension, Pregnancy-Induced ,Body Composition ,Pregnancy Trimesters ,Vascular Resistance ,Obstetrics and Gynecology ,medicine.disease ,medicine.anatomical_structure ,Settore MED/40 ,Hypertension ,Vascular resistance ,business - Abstract
Objectives To assess and correlate changes in body composition and haemodynamic function during pregnancy. To identify different haemodynamic profiles based on the onset of hypertensive diseases such as gestational hypertension and preeclampsia. Methods We enrolled 265 healthy, normotensive pregnant women throughout pregnancy (from 6 + 0 to 36 + 0 weeks). They were subjected to assessment of body composition and haemodynamic function using non-invasive methods. We divided our population in three groups: group A with physiological pregnancy, group B with gestational hypertension and group C with preeclamptic patients. Results In patients who developed gestational hypertension we found lower total body water (TBW) percentage, higher Fat Mass (FM), associated with lower Cardiac Output (CO) and higher Total Vascular Resistance (TVR) during the second trimester. In the third trimester we didn’t find haemodynamic differences, but a significative increase in extracellular water (ECW) percentage. In patients who developed preeclampsia we found since the first trimester significative higher TVR and hypodynamic circulation, associated with lower FM percentage. Conclusions Assessment of body composition and maternal cardiac function may help to identify earlier in pregnancy, patients with different (mal) adaptations to pregnancy. Women with high TVR, hypodynamic circulation and low fat mass during the first trimester, might be at higher risk to develop preeclampsia. Patients with higher BMI and FM percentage, and increased TVR in the second trimester, might be at risk of gestational hypertension and excessive fluid retention at the end of pregnancy.
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- 2017
26. Friendly help for clinical use of maternal hemodynamics
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D. Farsetti, I. Pisani, Barbara Vasapollo, Giulia Gagliardi, Herbert Valensise, Damiano Lo Presti, G. M. Tiralongo, and Gian Paolo Novelli
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medicine.medical_specialty ,Cardiac output ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Heart Rate ,Pregnancy ,medicine ,Humans ,Cardiac Output ,Intensive care medicine ,business.industry ,Hemodynamics ,Obstetrics and Gynecology ,medicine.disease ,Pregnancy Trimester, First ,medicine.anatomical_structure ,Settore MED/40 ,Pediatrics, Perinatology and Child Health ,Maternal hemodynamics ,Vascular resistance ,Female ,Vascular Resistance ,business - Abstract
Maternal hemodynamics plays a major role during pregnancy and its evaluation is fundamental to understand obstetric conditions. The modern opinion about maternal hemodynamics assessment is to shift focus from single hemodynamic parameters to the whole hemodynamic profile. Our aim is to create a simple, intuitive, and easily understandable graphing technique to evaluate the main hemodynamic parameters.We enrolled 531 pregnant women without maternal or fetal disease. One hundred and forty five in the first trimester of pregnancy, 258 in the second one and 128 in the third one. We performed hemodynamic assessment with ultrasonic cardiac output monitor method. We selected the six main parameters: cardiac output, systemic vascular resistance, heart rate, potential-to-kinetic energy ratio, inotropy index, and stroke volume variation. We chose the radar chart to display the multivariate data of the hemodynamic measurement of the patient in evaluation.We have obtained mean and deviation standard values for the six main hemodynamic parameters in every trimester. They deeply change during the pregnancy, so it is correct to compare a new hemodynamic measurement with the mean values for the specific trimester in order to evaluate any possible alterations. In fact, once a new hemodynamic assessment is performed, we calculate theAt the end of a hemodynamic exam, the physician can input the data in the program obtaining a graphic representation. Using this technique, which simultaneously evaluates six hemodynamic parameters, it is possible to easily understand the patient's hemodynamic status. By converting the parameters values in
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- 2019
27. Role of cardiovascular magnetic resonance end-systolic 3D-SSFP sequence in repaired tetralogy of Fallot patients eligible for transcatheter pulmonary valve implantation
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Carmela Napolitano, Davide Curione, Benedetta Leonardi, Aurelio Secinaro, Marco Alfonso Perrone, and Maria Giulia Gagliardi
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Balloon Valvuloplasty ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Pulmonary Circulation ,Adolescent ,Clinical Decision-Making ,Magnetic Resonance Imaging, Cine ,030204 cardiovascular system & hematology ,Prosthesis Design ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Predictive Value of Tests ,Pulmonary Valve Replacement ,Internal medicine ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Systole ,Cardiac Surgical Procedures ,Child ,Cardiac imaging ,Tetralogy of Fallot ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Observer Variation ,Cardiac cycle ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Hemodynamics ,Reproducibility of Results ,Magnetic resonance imaging ,Steady-state free precession imaging ,medicine.disease ,Pulmonary Valve Insufficiency ,medicine.anatomical_structure ,Treatment Outcome ,Pulmonary valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To evaluate the usefulness of cardiovascular magnetic resonance (CMR) 3D steady state free precession (SSFP) sequence acquired at end-systole (ES) in repaired Tetralogy of Fallot (rToF) patients eligible for percutaneous pulmonary valve implantation (PPVI). Between 2012 and 2018, 78 rToF patients were selected for pulmonary valve replacement (PVR) according to CMR criteria. CMR protocol included 3D-SSFP sequence used to assess the right ventricle outflow tract (RVOT) diameters at three levels (pulmonary valve remnant, mid-portion, bifurcation) in mid-diastole (MD) or ES, RVOT length and coronary artery anatomy. In 20 rToF patients without indications for PVR (controls), 3D SSFP sequence was acquired at both cardiac phases (MD and ES) to evaluate RVOT dimension throughout the cardiac cycle. Invasive balloon sizing was recorded in patients undergoing PPVI. The 3D-SSFP sequence was performed in MD on 39 patients and in ES on other 39, of whom 26 patients met the criteria for PPVI. The latter was unsuccessful in ten patients (38%), mainly due (80% of cases) to significant size discrepancy at PV remnant and bifurcation levels (p = 0.019 and 0.037 respectively) between the measurements by 3D-SSFP in MD and those by the balloon size in systole. Significant RVOT size difference between MD and ES was present at mid-portion and bifurcation levels in the PVR candidate group, and at all three-levels in the control group (all p
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- 2019
28. Laparoscopic liver resection for hepatocellular carcinoma in Fontan-associated chronic liver disease. The first case report
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Roberta Angelico, R. Pariante, Lidia Monti, Maria Cristina Saffioti, Veronica Lisignoli, Chiara Grimaldi, Marco Spada, and Maria Giulia Gagliardi
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Laparoscopic surgery ,FP, Fontan procedure ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Cirrhosis ,Hepatocellular carcinoma ,medicine.medical_treatment ,AFP, alphafetoprotein ,Chronic liver disease ,Article ,Fontan procedure ,Fontane procedure ,03 medical and health sciences ,0302 clinical medicine ,Pneumoperitoneum ,medicine ,cardiovascular diseases ,New technology ,RFA, radiofrequency ablation ,LLR, laparoscopic liver resection ,Liver resection ,business.industry ,CT, computer tomography ,medicine.disease ,Cardiac surgery ,Surgery ,Settore MED/18 ,Transplantation ,surgical procedures, operative ,030220 oncology & carcinogenesis ,CLD, chronic liver disease ,cardiovascular system ,030211 gastroenterology & hepatology ,business ,HCC, hepatocellular carcinoma ,human activities - Abstract
Highlights • Hepatocellular carcinoma after Fontan procedure is associated with high mortality. • Liver resection after Fontan procedure has high-risk liver/cardiac decompensation. • Laparoscopic liver resection is feasible with low intra-abdominal pressures. • Adequate anaesthetic management is essential in Fontan procedure patients. • Laparoscopic liver resection is a new therapeutic option after Fontan procedure., Introduction A well-recognized long-term complication after Fontan procedure (FP), a complex cardiac surgery performed in patients with univentricular hearts, is the development of chronic liver disease and hepatocellular carcinoma (HCC). Due to the risk of cardiac and liver decompensation, liver resection of HCC is challenging and the laparoscopic approach has never been reported. Presentation of the case We present the first case of laparoscopic liver resection (LLR) of HCC in a 33-years-old girl with cardiac-related cirrhosis after FP. Intraoperatively, the pneumoperitoneum was established at 8–10 mmHg and adequate fluid infusion was given to maintain the cardiac preload. After an ultrasound-guided thermoablation along the free-tumor margin of the hepatic lesion, a full laparoscopic non-anatomical resection of the tumor in segment V was performed, without Pringle manouver and blood transfusion requirement. The cardiac function remained stable during the surgery and thereafter, and the post-operative course was uneventful. Discussion HCC in chronic liver disease after FP is associated with high-risk mortality. Due to the complex hemodynamic changes after FP, open surgical resections often aren’t feasible and loco-regional percutaneous treatment or combined liver-heart transplantation are the only therapeutic options. This case suggests that LLR in FP patients has low-risk of liver and cardiac decompensation, minimizing the pneumoperitoneum insufflation to ensure low intra-abdominal/intra-thoracic pressures and providing accurate anaesthetic management to maintain proper cardiac preload and output. Conclusion LLR for HCC after FP is safe and feasible, and might be considered an alternative treatment of HCC for which the best treatment has not been defined yet.
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- 2019
29. Pregnancy in tetralogy of fallot: When and where
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Maria Giulia Gagliardi, Claudia Montanaro, and Rosaria Barracano
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medicine.medical_specialty ,Pregnancy ,business.industry ,RC666-701 ,Internal medicine ,Cardiology ,medicine ,Diseases of the circulatory (Cardiovascular) system ,medicine.disease ,business ,Tetralogy of Fallot - Published
- 2021
30. Dilated cardiomyopathy in children
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Giulia Gagliardi, Maria
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- 2006
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31. Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy
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Giulia Gagliardi, M., Bevilacqua, M., Bassano, C., Leonardi, B., Boldrini, R., Diomedi Camassei, F., Fierabracci, A., Ugazio, A.G., and Bottazzo, G.F.
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Myocarditis -- Drug therapy ,Myocarditis -- Research ,Myocarditis -- Patient outcomes ,Mortality -- Italy ,Immunosuppression -- Drug therapy ,Immunosuppression -- Patient outcomes ,Immunosuppression -- Research ,Cardiomyopathy, Dilated -- Care and treatment ,Cardiomyopathy, Dilated -- Research ,Cardiomyopathy, Dilated -- Patient outcomes ,Children -- Health aspects ,Children -- Diseases ,Pediatric research ,Health - Published
- 2004
32. Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?
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Giulia Gagliardi, D. Lo Presti, Gian Paolo Novelli, Barbara Vasapollo, Herbert Valensise, I. Pisani, D. Farsetti, and G. M. Tiralongo
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Cardiac output ,medicine.medical_specialty ,Population ,Cardiac index ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,education ,education.field_of_study ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Stroke volume ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,Premature birth ,Anesthesia ,Vascular resistance ,Cardiology ,business - Abstract
Objective To evaluate the maternal hemodynamic profile in women with a diagnosis of threatened preterm delivery (TPD) in order to understand the possible pathophysiologic mechanism leading to an increased lifetime risk for future cardiovascular disease. Methods Patients with a diagnosis of TPD were enrolled and assessed using a non-invasive method (USCOM®) for the determination of hemodynamic parameters. Vaginal and rectal swabs were taken, cervical length, blood inflammatory indices, fetal blood-vessel Doppler velocimetry were measured and gestational age at the time of delivery and neonatal outcomes were noted. Results A total of 68 patients were enrolled and included in the analysis. The population was divided into two groups according to total vascular resistance (TVR): Group A with a TVR of ≤ 1000 dynes × s/cm5 (n = 48) and Group B with a TVR of > 1000 dynes × s/cm5 (n = 20). C-reactive protein (CRP) was higher in Group B than in Group A, suggesting a systemic inflammation status. Group B delivered earlier (32 + 4 weeks vs 38 + 2 weeks; P 1000 dynes × s/cm5 and elevated levels of CRP are at high risk of preterm delivery. An impaired maternal cardiovascular adaptation during pregnancy in these patients might suggest a possible higher risk for subsequent future cardiovascular disease. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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- 2016
33. Hemodynamic Effects of Ventricular Assist Device Implantation on Norwood, Glenn, and Fontan Circulation: A Simulation Study
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Antonio Amodeo, Maria Giulia Gagliardi, Libera Fresiello, Alessandra Toscano, Gianfranco Ferrari, Maria Giovanna Trivella, Sergio Filippelli, and Arianna Di Molfetta
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medicine.medical_specialty ,Cardiac output ,medicine.medical_treatment ,0206 medical engineering ,Atrial Pressure ,Population ,Biomedical Engineering ,Medicine (miscellaneous) ,Hemodynamics ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Biomaterials ,Fontan procedure ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,cardiovascular diseases ,education ,Heart transplantation ,education.field_of_study ,business.industry ,General Medicine ,020601 biomedical engineering ,Ventricular assist device ,Cardiology ,Norwood procedure ,business - Abstract
The growing population of failing single-ventricle (SV) patients might benefit from ventricular assist device (VAD) support as a bridge to heart transplantation. However, the documented experience is limited to isolated case reports. Considering the complex and different physiopathology of Norwood, Glenn, and Fontan patients and the lack of established experience, the aim of this work is to realize and test a lumped parameter model of the cardiovascular system able to simulate SV hemodynamics and VAD implantation effects to support clinical decision. Hemodynamic and echocardiographic data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output and the mean arterial systemic pressure in all the three palliation conditions (Norwood 77.2 and 19.7%, Glenn 38.6 and 32.2%, and Fontan 17.2 and 14.2%); (ii) decreases the SV external work (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) decreases the pressure pulsatility index (Norwood 65.2%, Glenn 81.3%, and Fontan 64.8%); (iv) increases the pulmonary arterial pressure in particular in the Norwood circulation (Norwood 39.7%, Glenn 12.1% and Fontan 3%); and (v) decreases the atrial pressure (Norwood 2%, Glenn 10.6%, and Fontan 8.6%). Finally, the VAD work is lower in the Norwood circulation (30.4 mL·mm Hg) in comparison with Fontan (40.3 mL·mm Hg) and to Glenn (64.5 mL·mm Hg) circulations. The use of VAD in SV physiology could be helpful to bridge patients to heart transplantations by increasing the CO and unloading the SV with a decrement of the atrial pressure and the SV external work. The regulation of the pulmonary flow is challenging because the Pap is increased by the presence of VAD. The hemodynamic changes are different in the different SV palliation step. The use of numerical models could be helpful to support patient and VAD selection to optimize the clinical outcome.
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- 2015
34. Percutaneous treatment of aneurysmatic right coronary fistula in an infant, pediatric cardiology
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Maria Giulia Gagliardi, Paolo Guccione, Roberto Formigari, Danilo Montefoschi, and Arianna Di Molfetta
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Vascular Fistula ,medicine.medical_specialty ,Percutaneous ,business.industry ,Computed Tomography Angiography ,Coronary Vessel Anomalies ,Coronary Aneurysm ,Infant ,General Medicine ,Coronary Angiography ,Embolization, Therapeutic ,Surgery ,Coronary fistula ,Treatment Outcome ,medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Pediatric cardiology - Published
- 2018
35. Treatment of homozygous familial hypercholesterolaemia in paediatric patients: A monocentric experience
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Michaela Veronika Gonfiantini, Francesca Romano, Giovanna Leone, Maria Gnazzo, Gerarda Mastrogiorgio, Andrea Bartuli, Maria Giulia Gagliardi, Ippolita Rana, Paola Sabrina Buonuomo, Paola Valente, and Marina Macchiaiolo
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Epidemiology ,Rome ,Disease ,030204 cardiovascular system & hematology ,Compound heterozygosity ,Severity of Illness Index ,Hyperlipoproteinemia Type II ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Risk Factors ,Medicine ,Humans ,Genetic Predisposition to Disease ,030212 general & internal medicine ,Child ,Paediatric patients ,Whole blood ,Retrospective Studies ,business.industry ,Anticholesteremic Agents ,Homozygote ,Age Factors ,Cholesterol, LDL ,Apheresis ,Phenotype ,Treatment Outcome ,LDL apheresis ,Cardiovascular Diseases ,Child, Preschool ,Cohort ,Blood Component Removal ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background Homozygous familial hypercholesterolaemia is a rare life-threatening disease characterized by markedly elevated low-density lipoprotein cholesterol (LDL-C) concentrations and accelerated atherosclerosis. The presence of double gene defects in the LDL-Receptor, either the same defect (homozygous) or two different LDL-raising mutations (compound heterozygotes) or other variants, identify the homozygous phenotype (HopFH). Apheresis is a procedure in which plasma is separated from red blood cells before the physical removal of LDL-C or the LDL-C is directly removed from whole blood. It is currently the treatment of choice for patients with HopFH whose LDL-C levels are not able to be reduced to target levels with conventional lipid-lowering drug therapy. Design The aim of this study is to report a cohort of six paediatric patients and to evaluate the long term efficacy of combined medical therapy and LDL-apheresis on LDL-C reduction. Methods We collected data from six children with confirmed diagnosis of HopFH (two females and four males; age range at diagnosis 3–8 years, mean 6 ± 1 years) from a single clinical hospital in Italy from 2007 to 2017. Results Clinical manifestations and outcomes may greatly vary in children with HopFH. Medical therapy and LDL-apheresis for the severe form should be started promptly in order to prevent cardiovascular disease. Conclusions Lipoprotein apheresis is a very important tool in managing patients with HopFH at high risk of cardiovascular disease. Based on our experience and the literature data, the method is feasible in very young children, efficient regarding biological results and cardiac events, and safe with minor side-effects and technical problems. We advise treating homozygous and compound heterozygous children as soon as possible.
- Published
- 2018
36. OC28.05: Early and late pregnancy complications in chronic hypertension are linked to different hemodynamic states before and during gestation
- Author
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G. M. Tiralongo, Barbara Vasapollo, Herbert Valensise, I. Pisani, Giuseppe Novelli, D. Farsetti, and Giulia Gagliardi
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Hemodynamics ,General Medicine ,Late pregnancy ,Reproductive Medicine ,Medicine ,Gestation ,Radiology, Nuclear Medicine and imaging ,Chronic hypertension ,business - Published
- 2019
37. EP02.10: Evaluation of maternal hemodynamic and obstetric complications in pregnancy after assisted reproductive technology
- Author
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G. M. Tiralongo, Giulia Gagliardi, Herbert Valensise, D. Farsetti, M. Bernassola, Barbara Vasapollo, D. Lo Presti, and I. Pisani
- Subjects
Pregnancy ,medicine.medical_specialty ,Assisted reproductive technology ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,medicine.medical_treatment ,Obstetrics and Gynecology ,Hemodynamics ,General Medicine ,medicine.disease ,Reproductive Medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Published
- 2019
38. RF61 PREDICTING THE PRESSURE OF THE TOTAL CAVO-PULMONARY CONNECTION
- Author
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S. Rotella, Maria Giulia Gagliardi, Adriano Carotti, A. Di Molfetta, M. Massetti, Paolo Guccione, and Antonio Amodeo
- Subjects
Mathematical equations ,business.industry ,Calculus ,Medicine ,General Medicine ,Cardiology and Cardiovascular Medicine ,business ,Connection (mathematics) - Published
- 2018
39. Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective
- Author
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Maurizio Brighenti, Maristella Lombardi, Maria Giulia Gagliardi, Andrea Donti, Nicola Maschietto, Marco Bonvicini, Ugo Vairo, Gabriella Agnoletti, Davide Marini, Giacomo Pongiglione, and Ornella Milanesi
- Subjects
Pediatrics ,medicine.medical_specialty ,education.field_of_study ,Myocarditis ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Population ,Cardiomyopathy ,Retrospective cohort study ,Dilated cardiomyopathy ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,Medicine ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,education - 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
- 2015
40. Use of Ventricular Assist Device in Univentricular Physiology: The Role of Lumped Parameter Models
- Author
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Libera Fresiello, Gianfranco Ferrari, Maria Giulia Gagliardi, Antonio Amodeo, Sergio Filippelli, Roberta Iacobelli, and Arianna Di Molfetta
- Subjects
medicine.medical_specialty ,Cardiac output ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Diastole ,Medicine (miscellaneous) ,Hemodynamics ,Bioengineering ,02 engineering and technology ,030204 cardiovascular system & hematology ,Inferior vena cava ,Biomaterials ,Fontan procedure ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,cardiovascular diseases ,Systole ,business.industry ,General Medicine ,020601 biomedical engineering ,medicine.anatomical_structure ,medicine.vein ,Ventricular assist device ,Vascular resistance ,Cardiology ,business - Abstract
Failing single-ventricle (SV) patients might benefit from ventricular assist devices (VADs) as a bridge to heart transplantation. Considering the complex physiopathology of SV patients and the lack of established experience, the aim of this work was to realize and test a lumped parameter model of the cardiovascular system, able to simulate SV hemodynamics and VAD implantation effects. Data of 30 SV patients (10 Norwood, 10 Glenn, and 10 Fontan) were retrospectively collected and used to simulate patients' baseline. Then, the effects of VAD implantation were simulated. Additionally, both the effects of ventricular assistance and cavopulmonary assistance were simulated in different pathologic conditions on Fontan patients, including systolic dysfunction, diastolic dysfunction, and pulmonary vascular resistance increment. The model can reproduce patients' baseline well. Simulation results suggest that the implantation of VAD: (i) increases the cardiac output (CO) in all the three palliation conditions (Norwood 77.2%, Glenn 38.6%, and Fontan 17.2%); (ii) decreases the SV external work (SVEW) (Norwood 55%, Glenn 35.6%, and Fontan 41%); (iii) increases the mean pulmonary arterial pressure (Pap) (Norwood 39.7%, Glenn 12.1%, and Fontan 3%). In Fontan circulation, with systolic dysfunction, the left VAD (LVAD) increases CO (35%), while the right VAD (RVAD) determines a decrement of inferior vena cava pressure (Pvci) (39%) with 34% increment of CO. With diastolic dysfunction, the LVAD increases CO (42%) and the RVAD decreases the Pvci. With pulmonary vascular resistance increment, the RVAD allows the highest CO (50%) increment with the highest decrement of Pvci (53%). The single ventricular external work (SVEW) increases (decreases) increasing the VAD speed in cavopulmonary (ventricular) assistance. Numeric models could be helpful in this challenging and innovative field to support patients and VAD selection to optimize the clinical outcome and personalize the therapy.
- Published
- 2015
41. Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy. A key for the prevention of preeclampsia
- Author
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R.L. Scala, Angela Andreoli, Giulia Gagliardi, Giuseppe Novelli, Herbert Valensise, I. Pisani, Barbara Vasapollo, D. Lo Presti, and G. M. Tiralongo
- Subjects
Adult ,medicine.medical_specialty ,Cardiac output ,Complications of pregnancy ,Blood Pressure ,Gestational hypertension ,Hematocrit ,Settore BIO/09 ,Preeclampsia ,Body Water ,Pre-Eclampsia ,Heart Rate ,Pregnancy ,Internal medicine ,Electric Impedance ,Internal Medicine ,medicine ,Humans ,Early and late preeclampsia ,Prospective Studies ,Early pregnancy ,Bioimpedance ,medicine.diagnostic_test ,business.industry ,Obstetrics and Gynecology ,Stroke Volume ,Hypertension, Pregnancy-Induced ,Stroke volume ,medicine.disease ,Total vascular resistance ,Surgery ,Pregnancy Trimester, First ,medicine.anatomical_structure ,Blood pressure ,Vascular resistance ,Cardiology ,Inotropy index ,Female ,Vascular Resistance ,Settore MED/40 - Ginecologia e Ostetricia ,business - Abstract
Introduction Maternal cardiovascular system adapts to pregnancy, thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance and water body distribution. Abnormalities of these adaptive mechanisms are connected with hypertensive disorders. Objective To identify patients at a high risk of developing hypertensive complications of pregnancy during the first trimester of pregnancy, through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor) and Bioimpedance. Materials and methods We enrolled 120 healthy normotensive women during the first trimester of pregnancy obtaining all measurements with the USCOM system and Bioimpedance. Results 20 patients were excluded for a bad USCOM signal. The remaining patients ( n =100) were retrospectively divided into two groups: Group A ( n =75) TVR −5 , Group B ( n =25) TVR>1200dynesscm −5 . No statistically significant difference was identified in terms of water distribution, Fat Free Mass, Systolic/Diastolic Blood Pressure, Heart Rate, Hematocrit, Flow Time Corrected and Water Balance Index between the two groups. In contrast, higher values of the Cardiac Output, Stroke Volume, Fat Mass and Inotropy Index have been highlighted in the Group A. Moreover, in the Group A we found a better maternal–neonatal outcome and a lower incidence of hypertensive complications. Conclusions High TVR during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of water distribution and, in particular, with respect to the single blood pressure assessment. Moreover lower values of Inotropy Index could be an indicative of the worst cardiac performance.
- Published
- 2015
42. OC10.05: The 'Valensise Radar' to understand the maternal hemodynamic status
- Author
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Giuseppe Novelli, Barbara Vasapollo, D. Lo Presti, D. Farsetti, I. Pisani, Herbert Valensise, Giulia Gagliardi, and G. M. Tiralongo
- Subjects
medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Hemodynamics ,General Medicine ,law.invention ,Reproductive Medicine ,law ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Radar ,business - Published
- 2019
43. OP04.04: Maternal hemodynamics and computerised CTG in the identification of risk during labour
- Author
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Barbara Vasapollo, D. Lo Presti, Giulia Gagliardi, Giuseppe Novelli, D. Farsetti, I. Pisani, G. M. Tiralongo, and Herbert Valensise
- Subjects
medicine.medical_specialty ,Reproductive Medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Maternal hemodynamics ,Obstetrics and Gynecology ,Medicine ,Radiology, Nuclear Medicine and imaging ,Identification (biology) ,General Medicine ,business - Published
- 2019
44. RF21 EVOLUTION OF VENTRICULAR ENERGETICS IN THE DIFFERENT STAGES OF PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME
- Author
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Paolo Guccione, Antonio Amodeo, A. Di Molfetta, F. Cobianchi Bellisari, Adriano Carotti, M. Massetti, Maria Giulia Gagliardi, Roberta Iacobelli, and M. Rocchi
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Energetics ,medicine ,Cardiology ,General Medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Hypoplastic left heart syndrome ,Retrospective data - Published
- 2018
45. Coronary plaque composition assessed by intravascular ultrasound virtual histology: Association with long-term clinical outcomes after heart transplantation in young adult recipients
- Author
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Fabrizio Tomai, Anna S Ghini, Mara Pilati, Francesco Parisi, Maria Giulia Gagliardi, Giacomo Pongiglione, Alessandro Petrolini, Leonardo De Luca, and Rachele Adorisio
- Subjects
Heart transplantation ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Histology ,General Medicine ,Group A ,Group B ,Coronary plaque ,Internal medicine ,Intravascular ultrasound ,Cohort ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Young adult ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives To assess coronary plaque composition by virtual histology intravascular ultrasound (VH-IVUS) analysis in young adult recipients and to correlate these findings with time from heart transplant (HTx) and long-term outcomes. Background Rapid progression of coronary allograft vasculopathy after heart transplantation is a powerful predictor of mortality and clinical events at long-term. Methods Forty consecutive young adult recipients transplanted during childhood undergoing VH-IVUS during coronary surveillance have been prospectively included in this study. According to the time interval from HTx to VH-IVUS assessment, our cohort was divided into two groups (group A: ≤5 years, n = 13; group B: >5 years, n = 27). Results Group B showed an higher percentage of necrotic core and dense calcium (12 ± 2 vs. 5 ± 1%, P = 0.04; 8.2 vs. 2.1%, P = 0.03; respectively). An “inflammatory plaque” (necrotic core and dense calcium ≥30%) was detected in 34.8% of patients in group B and in none among group A patients (P = 0.03). Patients in group B had a number of adverse clinical events significantly higher than group A patients (53.8 vs. 14.3%; HR 4.45; 95% CI 1.62–12.16; P = 0.029) at long-term follow-up (4.2 years). The multivariate regression analysis showed that age (HR 1.5; 95% CI 1.1–2.0; P = 0.007), time from HTx (HR 1.8; 95% CI 1.6–4.8; P = 0.02), and inflammatory plaque (HR 2.4; 95% CI 1.1–5.3; P = 0.03) were independent predictors of adverse clinical events. Conclusions This study supports the hypothesis that time-dependent differences in plaque composition, as assessed by VH-IVUS, occur after HTx in young adult recipients, probably determining an increased risk of long-term clinical events. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
46. Fattori di rischio e di protezione nella valutazione delle competenze parentali di famiglie italiane e famiglie immigrate
- Author
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Luca Milani and Giulia Gagliardi
- Subjects
valutazione del rischio ,Settore M-PSI/04 - PSICOLOGIA DELLO SVILUPPO E PSICOLOGIA DELL'EDUCAZIONE ,Health (social science) ,Social Psychology ,protective factors ,Developmental and Educational Psychology ,risk factors ,risk assessment ,fattori protettivi ,fattori di rischio ,immigrazione ,immigration - Abstract
Secondo le stime demografiche piu recenti, la popolazione straniera residente in Italia e triplicata negli ultimi dieci anni. La condizione di migrante pone gli individui e i nuclei familiari in una condizione di particolare vulnerabilita, impegnati nel difficile compito di acculturazione e di mediazione tra la cultura di origine e quella di elezione, spesso in contesti relazionali e materialmente impoveriti. Nell’incontro tra Servizi e famiglie immigrate in condizioni di vulnerabilita, un aspetto di fondamentale importanza risiede nell’accurata valutazione del potenziale di rischio di maltrattamento. L’obiettivo della presente ricerca e quello di valutare l’efficacia del Protocollo sui fattori di rischio e protezione (Di Blasio, 2005) nelle indagini psicosociali con utenza di origine immigrata. A tal fine, sono state confrontate le cartelle sociali di 20 nuclei familiari di origine italiana e di 20 nuclei familiari di origine straniera, giunte all’attenzione dei Servizi per situazioni di vulnerabilita psicosociale e rischio di maltrattamento o abuso nei confronti della prole. I risultati mostrano come i fattori di rischio e di protezione individuati dal protocollo siano in grado sia di discriminare specifiche situazioni di rischio nella condizione di migranti sia di differenziare tra famiglie ad alto e basso rischio indipendentemente dalla provenienza dei nuclei familiari.
- Published
- 2013
47. Percutaneous Treatment of Abdominal Coarctation in Children Using a Covered Stent
- Author
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Giacomo Pongiglione, Maria Giulia Gagliardi, and Mara Pilati
- Subjects
medicine.medical_specialty ,Percutaneous ,Adolescent ,Prosthesis Design ,Aortography ,Aortic Coarctation ,Coated Materials, Biocompatible ,Restenosis ,medicine.artery ,medicine ,Humans ,Aorta, Abdominal ,Child ,Polytetrafluoroethylene ,Aorta ,business.industry ,Abdominal aorta ,Vascular surgery ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Cardiac surgery ,Descending aorta ,Pediatrics, Perinatology and Child Health ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Coarctation of the abdominal aorta is extremely rare. It generally involves a long segment of the descending aorta and causes uncontrolled and unexplainable hypertension in children. The therapeutic choice is very challenging because acute and chronic complications are reported for both the surgical and the percutaneous approaches. The two reported cases of abdominal coarctation were treated primarily and successfully through the use of covered stents. Three covered stents were implanted in two children. No complication occurred with either procedure. At this writing, an 18-month follow-up assessment has found the patients in good health with no restenosis at the coarctation site. Covered stent implantation in children with abdominal coarctation is a feasible, safe, and effective procedure. It provides adequate relief of symptoms and reduces the risk of aneurysm formation. To avoid covering important side branches with polytetrafluoroethylene, this type of procedure must be preceded by precise study of the aorta and its branches.
- Published
- 2013
48. Syndromic non-compaction of the left ventricle: associated chromosomal anomalies
- Author
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Bruno Dallapiccola, M. C. Digilio, Maria Giulia Gagliardi, Antonio Novelli, B. Marino, Anwar Baban, M.L. Dentici, Maria Cristina Roberti, Rossella Capolino, Paolo Versacci, Laura Bernardini, and Adriano Angioni
- Subjects
Genetics ,Candidate gene ,Cardiomyopathy ,Chromosomal translocation ,In situ hybridization ,Biology ,medicine.disease ,Subtelomere ,medicine.anatomical_structure ,Chromosome analysis ,Ventricle ,medicine ,Abnormality ,Genetics (clinical) - Abstract
Non-compaction of the left ventricle (NCLV) is a cardiomyopathy characterized by prominent left ventricular trabeculae and deep intertrabecular recesses. Associated extracardiac anomalies occur in 14–66% of patients of different series, while chromosomal anomalies were reported in sporadic cases. We investigated the prevalence of chromosomal imbalances in 25 syndromic patients with NCLV, using standard cytogenetic, subtelomeric fluorescent in situ hybridization, and array-comparative genomic hybridization (CGH) analyses. Standard chromosome analysis disclosed an abnormality in three (12%) patients, including a 45,X/46,XX mosaic, a 45,X/46,X,i(Y)(p11) mosaic, and a de novo Robertsonian 13;14 translocation in a child affected by hypomelanosis of Ito. Cryptic chromosome anomalies were found in six (24%) cases, including 1p36 deletion in two patients, 7p14.3p14.1 deletion, 18p subtelomeric deletion, 22q11.2 deletion associated with velo-cardio-facial syndrome, and distal 22q11.2 deletion, each in one case. These results recommend accurate clinical evaluation of patients with NCLV, and suggest that chromosome anomalies occur in about one third of syndromic NCLV individuals, without metabolic/neuromuscular disorder. Array-CGH analysis should be included in the diagnostic protocol of these patients, because different submicroscopic imbalances are causally associated with this disorder and can pinpoint candidate genes for this cardiomyopathy.
- Published
- 2012
49. Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients
- Author
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Herbert Valensise, Angela Andreoli, D. LoPresti, Giulia Gagliardi, Gian Paolo Novelli, I. Pisani, Barbara Vasapollo, G. M. Tiralongo, and D. Farsetti
- Subjects
Adult ,medicine.medical_specialty ,Body water ,Hemodynamics ,Intrauterine growth restriction ,Blood Pressure ,030204 cardiovascular system & hematology ,Ultrasonography, Prenatal ,Preeclampsia ,preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,bioimpedance ,Electric Impedance ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,bioimpedence ,Cardiac Output ,combined screening ,030219 obstetrics & reproductive medicine ,Eclampsia ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Pregnancy Trimester, First ,Reproductive Medicine ,Settore MED/40 ,Case-Control Studies ,cardiac function ,first trimester ,hemodynamics ,Body Composition ,Gestation ,Settore MED/40 - Ginecologia e Ostetricia ,Female ,Vascular Resistance ,business ,Body mass index ,Biomarkers - Abstract
Objective To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). Methods One hundred and fifty healthy nulliparous non-obese women (body mass index
- Published
- 2016
50. The Impact of Specific Viruses on Clinical Outcome in Children Presenting with Acute Heart Failure
- Author
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Carlo Bassano, Paola Francalanci, Mara Pilati, Francesca Saura, Alessandra Fierabracci, Marcello Chinali, Maria Giulia Gagliardi, and Isabella Giovannoni
- Subjects
Male ,Keywords: myocarditis ,Biopsy ,viruses ,Cardiomyopathy ,Settore MED/11 - Malattie dell'Apparato Cardiovascolare ,030204 cardiovascular system & hematology ,Polymerase Chain Reaction ,Ventricular Function, Left ,lcsh:Chemistry ,0302 clinical medicine ,Parvovirus B19, Human ,echocardiography ,030212 general & internal medicine ,Longitudinal Studies ,Child ,lcsh:QH301-705.5 ,Spectroscopy ,Ejection fraction ,longitudinal study ,Dilated cardiomyopathy ,Heart ,General Medicine ,Prognosis ,Computer Science Applications ,Myocarditis ,Child, Preschool ,Acute Disease ,Cardiology ,Female ,Cardiomyopathy, Dilated ,medicine.medical_specialty ,Adolescent ,virus ,Catalysis ,Article ,Inorganic Chemistry ,Parvoviridae Infections ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Humans ,Physical and Theoretical Chemistry ,Molecular Biology ,Survival rate ,Proportional Hazards Models ,Heart Failure ,Proportional hazards model ,business.industry ,Myocardium ,Organic Chemistry ,Infant ,medicine.disease ,myocarditis ,cardiomyopathy ,biopsy ,pediatric ,lcsh:Biology (General) ,lcsh:QD1-999 ,Heart failure ,DNA, Viral ,Etiology ,business ,Follow-Up Studies - Abstract
The presence and type of viral genomes have been suggested as the main etiology for inflammatory dilated cardiomyopathy. Information on the clinical implication of this finding in a large population of children is lacking. We evaluated the prevalence, type, and clinical impact of specific viral genomes in endomyocardial biopsies (EMB) collected between 2001 and 2013 among 63 children admitted to our hospital for acute heart failure (median age 2.8 years). Viral genome was searched by polymerase chain reaction (PCR). Patients underwent a complete two-dimensional echocardiographic examination at hospital admission and at discharge and were followed-up for 10 years. Twenty-seven adverse events (7 deaths and 20 cardiac transplantations) occurred during the follow-up. Viral genome was amplified in 19/63 biopsies (35%); PVB19 was the most commonly isolated virus. Presence of specific viral genome was associated with a significant recovery in ejection fraction, compared to patients without viral evidence (p < 0.05). In Cox-regression analysis, higher survival rate was related to virus-positive biopsies (p < 0.05). When comparing long-term prognosis among different viral groups, a trend towards better prognosis was observed in the presence of isolated Parvovirus B19 (PVB19) (p = 0.07). In our series, presence of a virus-positive EMB (mainly PVB19) was associated with improvement over time in cardiac function and better long-term prognosis.
- Published
- 2016
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