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Research Interests: Cardiology, Medicine, Electrocardiography, Echocardiography, Humans, and 13 moreInternal Medicine, Female, Infant, Mitochondrial Respiratory Chain, Clinical Sciences, Myocardium, Respiratory System, Public health systems and services research, Circulation, Endocardial Fibroelastosis, Complex I, Cardiovascular medicine and haematology, and Fatal outcome
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Acquired stenosis of normally connected pulmonary veins is a rare condition in children, usually associated with mediastinal processes. It may present later with a less specific clinical picture, symptoms and signs mimicking chronic lung... more
Acquired stenosis of normally connected pulmonary veins is a rare condition in children, usually associated with mediastinal processes. It may present later with a less specific clinical picture, symptoms and signs mimicking chronic lung disease. Fibrosing mediastinitis is a rarer disorder of unknown etiology, although several suspected causes such as granulomatous diseases, characterized by fibrous tissue proliferation within the mediastinum, leading to respiratory and cardiac failure by bronchial obstruction or pulmonary hypertension.
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Successful transcatheter device closure of secundum atrial septal defect has achieved worldwide acceptance with the clinical use of the Amplatz atrial septal occluder. However, device closure of multiple fenestrated secundum atrial septal... more
Successful transcatheter device closure of secundum atrial septal defect has achieved worldwide acceptance with the clinical use of the Amplatz atrial septal occluder. However, device closure of multiple fenestrated secundum atrial septal defects remains a challenge for the interventionist and in some cases may be only effectively closed surgically. This case report of multiple fenestrated atrial septal defects represents a further expansion of technologic efforts to improve the results and simplify the mechanism of device closure of fenestrated defects. When device closure with more than one device seems impractical or disadvantageous, consolidation of multiple defects in a fenestrated fossa ovalis by simple balloon atrial septostomy as demonstrated by this case report provides an easy mechanism to allow implantation of a single large device which will effectively close all of the defects. This approach is similar to the surgical approach for resection of the fenestrated membrane with secondary patch closure of the enlarged defect. Excellent and complete closure of a fenestrated secundum atrial septal defect is illustrated in this case report.
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Down patients frequently present congenital heart disease (CHD). Among these the most common is complete atrioventricular canal (CAV). The Authors studied by cardiac catheterization 2 groups of subjects with CAV:21 Down-patients, aged... more
Down patients frequently present congenital heart disease (CHD). Among these the most common is complete atrioventricular canal (CAV). The Authors studied by cardiac catheterization 2 groups of subjects with CAV:21 Down-patients, aged 5-48 months (mean = 24.7) and 17 non-Down patients aged 6-50 months (mean = 23.1). Hemodynamic data were compared and in particular pulmonary vascular resistances (PVR) were analysed. Mean pulmonary resistance was 11.1 UM2 for Down children and 4.6 UM2 for non-Down children. Considering the subjects under 2 years of age, PVR greater than or equal to 10 UM2 was present in 5 of 14 (35.7%). Down children, while none in the non-Down group. The cause of this behaviour is unknown; some Authors, in pathological studies, found in Down-patients primitive structural anomalies of the vascular bed with decrease of total vascular surface area. This fact might explain higher values of PVR in Down-patients than in non-Down patients.
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Background: In the last decade, body piercing has gained strongly in popularity. There are a few reports in the literature regarding infective endocarditis after body piercing. Case report: The case of an 18-year-old girl with heart... more
Background: In the last decade, body piercing has gained strongly in popularity. There are a few reports in the literature regarding infective endocarditis after body piercing. Case report: The case of an 18-year-old girl with heart failure and a six-month history of recurring fever is presented. Clinical and laboratory evaluation led to the diagnose of infective endocarditis due to Gemella morbillorum. Oral piercing was recognized to be the cause of bacteremia. Fourteen cases of infective endocarditis related to body piercing were found in the literature and the clinical, etiologic, pathogenic, and preventive aspects of this topic are presented. Conclusions: Infective endocarditis may be a complication of body piercing and has been observed in patients with heart lesions as well as in previous healthy people. Infective endocarditis can follow body piercing involving either mucous membranes or the skin. This patient is the first case of Gemella morbillorum endocarditis after body piercing reported in the literature. Careful observation for infection at the site of piercing and its treatment as well as professional training for operators seem to be the most effective way to minimize the risk of infective endocarditis after body piercing.
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Stroke is a rare disorder in childhood. The majority of these cases is of an ischemic nature. In spite of the long list of known causes, many strokes remain undetermined, so-called cryptogenic strokes. Increasing evidence indicates that,... more
Stroke is a rare disorder in childhood. The majority of these cases is of an ischemic nature. In spite of the long list of known causes, many strokes remain undetermined, so-called cryptogenic strokes. Increasing evidence indicates that, in the young adults, many cases of cryptogenic stroke are presumably due to paradoxical embolism. In childhood, this is usually not considered, unless in the context of a complex cyanotic heart disease. We present two cases, a 6-year-old boy and an 11-year-old girl who had an episode of cerebral ischemia documented by MRI, and in whom the only anomaly found was a patent foramen ovale (PFO) with intermittent left to right shunt at rest, but with a large right to left shunt during the Valsalva maneuvre. We assumed that, in our cases, in the absence of identifiable causes, the cerebral ischemia was most likely due to paradoxical embolism through the PFO. Of course, as in the adult, the paradoxical embolism could not be proved, but in our opinion it remains the most concrete possibility. Therefore, in presence of a cryptogenic stroke, a PFO should be investigated also in children.
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Research Interests: Adolescent, Medicine, Catheterization, Echocardiography, Stroke, and 15 moreHumans, Child, Female, Male, Mayo Clinic, Young Adult, Adult, Mayo Clinic Proceedings, Transient Ischemic Attack (TIA), Atrial Septal Defect, Patent Foramen Ovale, Asd, Child preschool, Paradoxical embolism, and Medical and Health Sciences
This is a case report of a Fontan patient with previous Potts anastomosis who underwent stent implantation for left pulmonary artery stenosis. At follow‐up the patient developed a fistula between the descending thoracic aorta and the left... more
This is a case report of a Fontan patient with previous Potts anastomosis who underwent stent implantation for left pulmonary artery stenosis. At follow‐up the patient developed a fistula between the descending thoracic aorta and the left pulmonary artery at the site of the stent. This represents a late complication of stent placement.
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We report a surgical treatment for neonatal aortic coarctatin associated with distal aortic arch hypoplasia. This technique offers the possibility for augmentation of the aortic arch without sacrificing the subclavian artery or using... more
We report a surgical treatment for neonatal aortic coarctatin associated with distal aortic arch hypoplasia. This technique offers the possibility for augmentation of the aortic arch without sacrificing the subclavian artery or using prosthetic patch material. The procedure was successfully performed in 5 patients.
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Research Interests: Cardiology, Medicine, Electrocardiography, Echocardiography, Humans, and 13 moreInternal Medicine, Female, Infant, Mitochondrial Respiratory Chain, Clinical Sciences, Myocardium, Respiratory System, Public health systems and services research, Circulation, Endocardial Fibroelastosis, Complex I, Cardiovascular medicine and haematology, and Fatal outcome
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Research Interests: Engineering, Chemistry, Cardiology, Molecular Biology, Biology, and 15 moreImmunohistochemistry, Medicine, Multidisciplinary, Electrocardiography, Internal Medicine, Animals, Male, Cardiac Arrhythmias, Myocardial Infarction, Conduction Velocity, Arrhythmia, Infarct Size, Growth Factor, Insulin Like Growth Factor, and Hepatocyte Growth Factor
Research Interests: Medicine, Echocardiography, Humans, Internal Medicine, Developing Country, and 15 moreMale, Infant, Follow-up studies, Differential Diagnosis, Kawasaki Disease, Anticoagulants, Heart Disease, Cardiac Catheterization, Coronary Angiography, Combination drug therapy, Coronary Artery Disease, Coronary artery, Signs and Symptoms, Paediatrics and reproductive medicine, and Coronary Aneurysm
The Senning operation for transposition of the great arteries (TGA) was first introduced by Senning in 1959 and was revived by Quaegebeur et al. in the late 1970s, thus becoming the intervention of choice for the correction of TGA in many... more
The Senning operation for transposition of the great arteries (TGA) was first introduced by Senning in 1959 and was revived by Quaegebeur et al. in the late 1970s, thus becoming the intervention of choice for the correction of TGA in many centers. The purpose of this study was to evaluate the long-term follow-up of a group of patients undergoing surgery with the Senning procedure for TGA. From November 1978 to November 1987, 73 consecutive patients underwent the Senning operation. The 70 survivors had an average follow-up of 19 years (16-25 years). (1) Cardiac rhythm: with time there was a progressive decrease in stable sinus rhythm (60% after 20 years) and a progressive increase of supraventricular tachyarrhythmias requiring therapy (10% after 20 years). (2) Right ventricular function: 20% of the patients had reduced ejection fraction. (3) Late mortality: in the last 12 years of follow-up years there were two sudden deaths (2.8%). (4) Functional status: 80% of patients were in NYHA class I, 17% in class II, and 3% in class III. Our results confirm that the patients who undergo the Senning procedure have a progressive loss of sinus rhythm, an increase in active arrhythmias, and other important adverse outcomes such as late sudden death and a decrease in right ventricular function; however, most patients (93% in our series) are alive and in good functional status.
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BACKGROUND AND AIM OF THE WORK Syncope occurs frequently in childhood and adolescence. It generally is benign, but may be a sign of pathology. The purpose of this study is to determine the incidence of syncope in children and adolescents... more
BACKGROUND AND AIM OF THE WORK Syncope occurs frequently in childhood and adolescence. It generally is benign, but may be a sign of pathology. The purpose of this study is to determine the incidence of syncope in children and adolescents in the Parma area, analyse the frequency of syncope due to cardiac, neurological or metabolic diseases, to identify a diagnostic procedure based on careful review, clinical features, and results of investigations. METHODS The records of 156 children (age 1 to 18 years, mean age 10.5), who were referred to the Paediatric Department for syncope were reviewed. RESULTS The incidence of syncope in the paediatric population of Parma during a 2-year period (2005-2006) resulted in 86.5/100.000 per year. The cause of syncope was discovered in 154/156 cases. Cardiovascular syncope was diagnosed in 121/156 cases (77.5%). Neurological syncope was diagnosed in 31/156 cases (20%), while metabolic syncope was diagnosed in 2/156 cases (1.25%). The most frequent typ...
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Cardiac disproportion is considered as an indirect sign of coarctation of the aorta (CoA). In this review, we have reassessed the positive predictive value (PPV) of such finding for a postnatal confirmation of CoA. All cases of isolated... more
Cardiac disproportion is considered as an indirect sign of coarctation of the aorta (CoA). In this review, we have reassessed the positive predictive value (PPV) of such finding for a postnatal confirmation of CoA. All cases of isolated cardiac disproportion diagnosed in the four-chamber and/or three-vessel/three-vessel and trachea views (right/left sections >1.5) were included. Postnatal cardiac findings were recorded. Additionally, a systematic literature search (PubMed, EMBASE, Cochrane library, and the reference lists of identified articles) regarding the association between antenatally detected cardiac disproportion and postnatal confirmation of CoA was performed. Data from our center were pooled with those derived from the literature. Ten fetuses with isolated cardiac disproportion were selected from our center and 259 from the literature review. CoA was postnatally confirmed in 101/269 (PPV 38%). PPV of antenatal cardiac findings was significantly higher in earlier gestation (23/27, 85% <26(+0 )weeks versus 11/39, 28%≥26(+0 )weeks, p < .001). No significant difference was noticed comparing ventricular disproportion with combined ventricular and great vessels disproportion (86/230 versus 15/39, p .89). Isolated cardiac disproportion has an overall chance of one in three of heralding a CoA in the neonate. The specificity of these findings is significantly higher in the second trimester.
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Outlet ventricular septal defects (VSDs) are usually suspected on the five-chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic... more
Outlet ventricular septal defects (VSDs) are usually suspected on the five-chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs. Cases where isolated outlet VSD was suspected on the five-chamber view were assessed by using the short axis scanning plane for confirmation of the defect. Postnatal assessment was performed within 2 weeks from birth at our Paediatric Cardiology Unit. An outlet VSD was suspected at five-chamber view in 23 fetuses. Postnatal confirmation of the VSD occurred in 14 cases where the defect was prenatally detected both on the five chamber and the short axis views. VSDs were not confirmed at postnatal assessment only in two cases where outlet VSD was suspected on both views, whereas all the seven cases with a suspected VSD on the five-chamber view only turned out to be false positives. The short axis view of the fetal heart seems useful in confirming the presence of outlet VSDs. © 2016 John Wiley & Sons, Ltd.
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Acquired stenosis of normally connected pulmonary veins is a rare condition in children, usually associated with mediastinal processes. It may present later with a less specific clinical picture, symptoms and signs mimicking chronic lung... more
Acquired stenosis of normally connected pulmonary veins is a rare condition in children, usually associated with mediastinal processes. It may present later with a less specific clinical picture, symptoms and signs mimicking chronic lung disease. Fibrosing mediastinitis is a rarer disorder of unknown etiology, although several suspected causes such as granulomatous diseases, characterized by fibrous tissue proliferation within the mediastinum, leading to respiratory and cardiac failure by bronchial obstruction or pulmonary hypertension.
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Acquired stenosis of normally connected pulmonary veins is a rare condition in children, usually associated with mediastinal processes. It may present later with a less specific clinical picture, symptoms and signs mimicking chronic lung... more
Acquired stenosis of normally connected pulmonary veins is a rare condition in children, usually associated with mediastinal processes. It may present later with a less specific clinical picture, symptoms and signs mimicking chronic lung disease. Fibrosing mediastinitis is a rarer disorder of unknown etiology, although several suspected causes such as granulomatous diseases, characterized by fibrous tissue proliferation within the mediastinum, leading to respiratory and cardiac failure by bronchial obstruction or pulmonary hypertension.
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Various devices have been developed for the percutaneous closure of persistent patent ductus arteriosus (PDA). In recent years Gianturco coils have become increasingly widespread for this purpose. Poor control during positioning is a... more
Various devices have been developed for the percutaneous closure of persistent patent ductus arteriosus (PDA). In recent years Gianturco coils have become increasingly widespread for this purpose. Poor control during positioning is a major disadvantage of Gianturco coils, with resultant embolization of coils and residual shunts. Very recently a new screwing detachable coil is available (Cook Cardiology, Europe). Between January 1996 and January 2000, 34 consecutive patients with PDA underwent cardiac catheterization. Thirty cases were judged suitable for this procedure, on the base of diameter and morphology of the ductus. Three cases were excluded because of the ductal diameter was too large (> 4.2 mm) and one because of its morphology (type B). In 28 patients a single coil was positioned, while in one case 2 coils were simultaneously used. In 29 cases (97%) complete closure was obtained (in 18 cases immediately, in 6 after 24 hours, in 5 after 1 month). One case showed a residu...