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BACKGROUND: In patients undergoing mitral valve surgery, restrictive suture annuloplasty (De Vega) for less-than-severe functional tricuspid regurgitation has been proven to be safe and effective. The aim of this study is to determine whether the adjunct of the plication of the posterior tricuspid leaflet with the same running suture (bicuspidized De Vega or "De Kay") is equally safe and effective.METHODS: Single center, retrospective study on patients submitted to suture repair of the tricuspid valve during mitral valve surgery, with either conventional or De Kay, between January 2014 and December 2020. Comparison was based on degree of residual tricuspid valve regurgitation and right ventricular assessment at discharge.RESULTS: Over the course of the study period, 255 patients undergoing mitral valve surgery had a dilated (>40 mm or >20 mm/m2) tricuspid valve annulus, with less-than-severe tricuspid regurgitation. Conventional De Vega was employed in 166 patients (65.1%) and De Kay in the remaining 89 (34.9%). At discharge the adjunct of postero-septal commissure plication has similar outcomes to the classic De Vega repair. ItCONCLUSIONS: De Kay repair guarantees the same tricuspidal regurgitation reduction as compared with conventional De Vega early after (Cite this article as: Bruno P, Grandinetti M, Farina P, D'Avino S, Graziani F, Calabrese M, et al. Comparison of De-Kay repair versus De Vega suture for functional tricuspid regurgitation: a preliminary experience. J Cardiovasc Surg 2023;64:437-42. DOI: 10.23736/S0021-9509.23.12565-1)

BackgroundThe clinical impact of valvular heart disease (VHD) in adult congenital heart disease (ACHD) patients is unascertained. Aim of our study was to assess the prevalence and clinical impact of severe VHD (S-VHD) in a real-world contemporary cohort of ACHD patients. Materials and methodsConsecutive patients followed-up at our ACHD Outpatient Clinic from September 2014 to February 2021 were enrolled. Clinical characteristics and echocardiographic data were prospectively entered into a digitalized medical records database. VHD at the first evaluation was assessed and graded according to VHD guidelines. Clinical data at follow-up were collected. The study endpoint was the occurrence of cardiac mortality and/or unplanned cardiac hospitalization during follow-up. ResultsA total of 390 patients (median age 34 years, 49% males) were included and S-VHD was present in 101 (25.9%) patients. Over a median follow-up time of 26 months (IQR: 12-48), the study composite endpoint occurred in 76 patients (19.5%). The cumulative endpoint-free survival was significantly lower in patients with S-VHD vs. patients with non-severe VHD (Log rank p < 0.001). At multivariable analysis, age and atrial fibrillation at first visit (p = 0.029 and p = 0.006 respectively), lower %Sat O-2, higher NYHA class (p = 0.005 for both), lower LVEF (p = 0.008), and S-VHD (p = 0.015) were independently associated to the study endpoint. The likelihood ratio test demonstrated that S-VHD added significant prognostic value (p = 0.017) to a multivariate model including age, severe CHD, atrial fibrillation, %Sat O2, NYHA, LVEF, and right ventricle systolic pressure > 45 mmHg. ConclusionIn ACHD patients, the presence of S-VHD is independently associated with the occurrence of cardiovascular mortality and hospitalization. The prognostic value of S-VHD is incremental above other established prognostic markers.

Background: Valvular heart disease (VHD) requires optimized outpatient management that is generally considered to be best delivered by a dedicated, multidisciplinary team (Heart Valve Clinic [HVC]). Although HVC is promoted by clinical guidelines and organized in many centers, real world outcome assessments are limited. Thus, we evaluated the performance, clinical and management outcomes during a 6-year experience with an original HVC model. Methods: By interrogating the local database, 1047 consecutive patients admitted to the HVC from January 2015 to October 2020 were found. Management and mortality were checked for all patients. After 3 years of HVC activity, in order to improve appropriateness and efficiency, access priority criteria were introduced. Thus, the study population was divided in two period subgroups (before and after access criteria introduction) that were compared. Results: A total of 1047 consecutive patients admitted to the HVC constituted the study population; 346 patients (33%) were recommended for invasive treatment. After a mean follow-up of 25.7±3.1 months, 37 patients (3.5%) died. When comparing study periods, statistically significant increase inpatients' complexity and VHD severity was noticed in Period 2, also translating into higher rate of referral to intervention (39.0% vs. 29.4% in Period 1; P=0.001). Finally, despite higher rate of elderly and frail patients, operative mortality was not jeopardized. Conclusions: The present study reports a comprehensive assessment of the characteristics and outcomes achieved through an original HVC model. Standardization of access criteria supports the HVC improvement.

Background. - Right ventricle-pulmonary artery (RV-PA) coupling is a strong prognostic marker in several clinical settings, but few studies have focused on its role in repaired tetralogy of Fallot (rToF) with pulmonary regurgitation.Aim. - To assess whether differences exist in RV-PA coupling, estimated by echocardiography, between patients with rToF and pulmonary regurgitation with or without an indication for pulmonary valve replacement (PVR).Methods. - The study population included 40 patients with rToF, who were allocated to two groups: 20 with an indication for PVR (i-PVR group); and 20 without an indication for PVR (ni-PVR group). Forty healthy controls were also included. All subjects underwent echocardiography, and cardiac magnetic resonance (CMR) was available in 27/40 patients with rToF. RV-PA coupling was assessed by echocardiographic tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) and right ventricular stroke volume/right ventricular end-systolic volume (RVSV/RVESV) by CMR.Results. - TAPSE was similar in the i-PVR and ni-PVR groups (19.0 +/- 3.4 vs 18.8 +/- 2.7 mm; P = 0.97) whereas RV-PA coupling was significantly worse in the i-PVR group versus the niPVR group (TAPSE/PASP 0.8 +/- 0.3 vs 1.1 +/- 0.5 mm/mmHg; P = 0.001), and in the i-PVR group versus the control group (P = 0.02); there was no difference between the ni-PVR and control groups (P = 0.29). CMR data confirmed the echocardiography results, with a significant difference in RV-PA coupling between the i-PVR and ni-PVR groups (RVSV/RVESV 0.9 +/- 0.2 vs 1.2 +/- 0.3 mL/min/mL; P = 0.01).Conclusions. - This study demonstrates worse RV-PA coupling, despite normal RV systolic function, in patients with rToF with an indication for PVR. RV-PA coupling could be a sensitive marker of a progressive maladaptive RV response to long-standing volume overload in rToF before the onset of clinical symptoms and RV systolic dysfunction. (C) 2022 Elsevier Masson SAS. All r

AIM: To summarize our experience on the implementation of a telemedicine service dedicated to adult congenital heart disease (ACHD) patients during the lockdown for the first wave of Coronavirus disease 2019 (COVID-19). METHODS: This is a prospective study enrolling all ACHD patients who answered a questionnaire dedicated telematic cardiovascular examination. RESULTS: A total of 289 patients were enrolled, 133 (47%) were male, 25 (9%) were affected by a genetic syndrome. The median age was 38 (29-51) years, whereas the median time interval between the last visit and the telematic follow-up was 9.5 (7.5-11.5) months. Overall, 35 patients (12%) reported a worsening of fatigue in daily life activity, 17 (6%) experienced chest pain, 42 (15%) had presyncope and 2 (1%) syncope; in addition, 28 patients (10%) presented peripheral edema and 14 (5%) were orthopneic. A total of 116 (40%) patients reported palpitations and 12 had at least one episode of atrial fibrillation and underwent successful electrical (8) or pharmacological (4) cardioversion. One patient was admitted to the emergency department for uncontrolled arterial hypertension, five for chest pain, and one for heart failure. Two patients presented fever but both had negative COVID-19 nasal swab. CONCLUSION: During the COVID-19 pandemic, the use of telemedicine dramatically increased and here we report a positive experience in ACHD patients. The postpandemic role of telemedicine will depend on permanent regulatory solutions and this early study might encourage a more systematic telematic approach for ACHD patients.

Background: Progressive right heart chambers dilatation is frequent in the adult congenital heart disease (ACHD) population. We evaluated the immediate and mid-term response of right heart chambers to surgery performed in adulthood for lesions associated with right heart chambers enlargement. Methods: Thirty-six adult patients with lesions associated with right heart chambers enlargement submitted to surgery were studied. We collected echocardiographic data of right ventricle (RV) mid-diameter, right atrial volume indexed, RV systolic pressure, and tricuspid annular plane systolic excursion (TAPSE) prior to surgery (T0), at 2 to 5 days (T1), and 3 to 6 months (T2) after surgery. Results: At T1, we observed a significant decrease of RV mid-diameter (47.2 +/- 8.4 vs. 39.6 +/- 7.4 mm, P<.001), right atrial volume indexed (45.6 +/- 26.6 vs. 27.2 +/- 11 ml/m2, P<.001), and RV systolic pressure (39 +/- 14.8 vs. 32.8 +/- 11.3 mm Hg, P=.03). At T2, a further significant deviation in the rate of RV diameter (39.6 +/- 7.4 vs. 34.5 +/- 5.1 mm, P<.001), in RV systolic pressure (32.8 +/- 11.3 vs. 25.3 +/- 5 mm Hg, P=.03) and TAPSE (13.9 +/- 3.2 vs. 15.8 +/- 2.6 mm, P<.001) was observed. Conclusions: Positive right heart chambers remodeling occurs as early as in the immediate post-operative period in most ACHD patients operated for lesions associated with right heart chambers enlargement.

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This thesis examines the effects of flooding on coastal and salt marsh vegetation. I conducted a field experiment in Bellocchio Lagoon to test the effects of different inundation periods (Level 1 = 0.468 or 11.23 hours; Level 2 = 0.351 or 8.42 hours; Level 3 = 0.263 or 6.312 hours; Level 4 = 0.155 or 3.72 hours; Level 5 = 0.082 or 1.963 hours; Level 6 = 0.04 or 0.96 hours) on the growth responses and survival of the salt marsh grass Spartina maritima in summer 2011 and 2012. S. maritima grew better at intermediate inundation times (0,351 hours; 0,263 hours, 0,115 hours; 0,082 hours), while growth and survival were reduced at greater inundation periods (0,468 hours). The differences between the 2011 and 2012 experiment were mainly related to differences in the initial number of shoots (1 and 5, respectively in 2011 and 2012). In the 2011 experiment a significant lower number of plants was present in the levels 1 and 6, the rhizomes reached the max pick in level 4, weights was major in level 4, spike length reached the pick in level 3 while leaf length in level 2. In the 2012 experiment the plants in level 6 all died, the rhizomes were more present in level 3, weights was major in level 3, spike length reached the pick in level 3, as well as leaf length. I also conducted a laboratory experiment which was designed to test the effects of 5 different inundation periods (0 control, 8, 24, 48, 96 hours) on the survival of three coastal vegetation species Agrostis stolonifera, Trifolium repens and Hippopae rhamnoides in summer 2012. The same laboratory experiment was repeated in the Netherlands. In Italy, H. rhamnoides showed a great survival in the controls, a variable performance in the other treatments and a clear decrease in treatment 4. Conversely T. repens and A. stolonifera only survive in the control. In the Netherlands experiment there was a greater variability responses for each species, still at the end of the experiment survival was significantly smaller in trea