Long QT syndrome and left ventricular non-compaction in a family with KCNH2 mutation: A case report

Background: Left ventricular non-compaction (LVNC) is an abnormality of the myocardium, characterized by prominent left ventricular trabeculae and deep inter-trabecular recesses. Long QT syndrome (LQTS) is a cardiac ion channelopathy presenting with a prolonged QT interval on resting electrocardiogram and is associated with increased susceptibility to sudden death. The association between LVNC and LQTS is uncommon. Case presentation: We report an Italian family with a novel pathogenic KCNH2 variant who presented with clinical features of LVNC and LQTS. The proband came to our attention after two syncopal episodes without prodromal symptoms. His ECG showed QTc prolongation and deep T wave inversion in anterior leads, and the echocardiogram fulfilled LVNC criteria. After that, also his sister was found to have LQTS and LVNC, while his father only presented LQTS. Conclusions: Physicians should be aware of the possible association between LVNC and LQTS. Even if this association is rare, patients with LVNC should be investigated

Prevalence of Thromboembolic Complications in COVID-19 Infection: A Systematic Review and Meta-Analysis

Introduction: The coronavirus disease (COVID-19) infection is proved to be involved in the onset of thromboembolism episodes. This study aims to evaluate the prevalence of thromboembolic complications in patients with COVID-19 from March until May 2020. Methods: A literature review was conducted in MEDLINE (via PubMed), Scopus, Embase, Cochrane, and CINHAL without any language and date of publication restriction (Prospero registration number CRD42020186925). The inclusion criteria were as following: 1) patients with diagnosis of COVID-19; 2) occurrence of thromboembolic event, and 3) patients older than 18 years of age. A multi-variable random effects model was computed accounting for correlations among outcomes by considering a heterogeneous compound symmetry covariance matrix. Results: Observational studies included 2,442 participants from 268 to 7,999 participants per study, 1,014 (41.52%) were male and 825 (33.78%) were female. The multi-variable pooled event rate of acute myocardial infarction was rare, estimated to be 0.03 (95% confidence interval [CI]: 0.00–0.07; p=0.23); this is also true for the meta-analytical estimate of disseminated intravascular disease which was 0.04 (95% CI: 0.00–0.08; p=0.03). Conversely, other events were found to be more frequent. Indeed, the pooled proportion of pulmonary embolism was 0.14 (95% CI: 0.08–0.20; p<0.001), while the venous thromboembolic event rate is 0.15 (95% CI: 0.09-0.30; p=0.04). The pooled intrahospital mortality rate was equal to 0.12 (95% CI: 0.08–0.16; p<0.001). Conclusions: Thromboembolic events, particularly venous thromboembolic event rate and pulmonary embolism, are a frequent complication in patients hospitalised with COVID-19. These findings suggest that the threshold for clinical suspicion should be low to trigger prompt diagnostic testing and that evaluation of therapeutic treatment should be considered in patients in intensive care units with COVID-19

Successful transvenous mechanical lead extraction and stent implantation in a patient after Mustard palliation for D-transposition of great arteries and superior vena cava syndrome

We report a successful combined approach of transvenous mechanical pacing lead extraction and stent angioplasty for superior baffle occlusion in a young woman with D-transposition of great artery after Mustard procedure. After having extracted the pacing leads, the baffle was easily stented, thanks to the channel left by the extracted leads. Eventually, a new pacing lead was implanted into the pulmonic ventricle through the stented baffle. Our report demonstrates the safeness and feasibility of a combined interventional approach in avoiding the need for surgery

Cardiac Arrhythmias in Pediatric Age: Are They Triggered by SARS-CoV-2 Infection?

Coronavirus disease 2019 is a highly contagious infectious disease. Research on heart rhythm disorders in children affected by COVID-19 infection is quite lacking. An infant and a congenital heart disease (CHD) teenager with a pacemaker presented fascicular tachycardia and atrial flutter, respectively, during COVID-19 pauci-symptomatic infection. The hemodynamic condition was always stable. The self-resolving trend of the atrial flutter and progressive resolution of the ventricular tachycardia occurred in conjunction with the negativization of the swab. These particular tachyarrhythmias have been reported as a form of potential arrhythmic complication during active pauci-symptomatic COVID-19 infection for the first time ever

NEUROHORMONES IN MITRAL STENOSIS BEFORE AND AFTER PERCUTANEOUS BALLOON MITRAL VALVOTOMY

BACKGROUND AND AIM OF THE STUDY: The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients in sinus rhythm (SR) and with atrial fibrillation (AF). The study aim was to evaluate the effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis in SR and AF. METHODS: Thirty-one patients (26 females, five males; mean age 50.5+/-14 years) with pure rheumatic mitral stenosis underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting in a supine position for > or =2 h. Digitalis and diuretics were withdrawn 48 h before sampling; neither had patients received ACE inhibitors or beta-blockers during the previous month. RESULTS: PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index was increased in both groups, but was distinctly lower in AF patients both before and after PBMV. CONCLUSION: Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, most likely because in AF patients a low cardiac index elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR

Pressure-dependence of the Aortic Valve Gradient

Dipendenza lineare el gradiente transaortico dalla pressione sistolica aortica e dalle resistenze periferich