Effects of Essential Hypertension on coronary Microcirculation: Focus on a Population of Hypertensives Affected by Microvascular Angina

A correlation between essential hypertension and the establishmentof myocardial ischemia is nowadays universally accepted. Coronary atherosclerosis is deemed to be the most important process through which the capability of coronary district to supply a blood flow consistent with myocardial needs can be impaired, until the onset of an anginal syndrome. In this study, we verified whether hypertensives’ coronaries, seen by performing an angiographic study, are properly definable as normal, even in presence of an overt exertional angina, or if they should rather be barely defined as “macroscopically unharmed”, through the clues of a microvascular alteratio

Microvascular angina in diabetic patients with uninjured coronary arteries

Abstrac

Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

BackgroundClosure of paravalvular leak (PVL) regurgitation after self-expandable (SE) transcatheter aortic valve implantation (TAVI) may be more challenging than after balloon-expandable (BE) valve implantation.Case summaryAn 85-year-old woman suffering from long-standing atrial fibrillation and severe symptomatic aortic stenosis underwent SE TAVI (26 mm Evolut™ R®, Medtronic Inc., MN, USA). A total of eighteen months after TAVI she was admitted for congestive heart failure and two-dimensional (2D) transesophageal echocardiography (TEE) color Doppler showed moderate-severe PVL regurgitation due to a long and heavily calcified leak located below the left coronary sinus. The patient was deemed to be at prohibitive surgical risk and a catheter-based PVL closure procedure was planned. A first attempt to cross the PVL from the femoral artery was unsuccessful due to an inappropriate angle between the catheter and the entry site of this hard-to-approach calcified leak. A Terumo hydrophilic guidewire 0.35 inch-260 cm from the right radial artery was then successfully advanced across the leak to the left ventricle (LV); however, of most of the catheters used, only a Glidecath 4-Fr could cross the leak over the hydrophilic wire. The hydrophilic guidewire was replaced with a stiffer guidewire that, after creating a loop in the LV, was advanced across the self-expandable valve into the descending aorta where it was snared and externalized through the left femoral artery, thus creating an arterio-arterial (AA) loop. A 6-Fr Multipurpose guiding catheter was advanced over the exchange wire and the leak was crossed with an additional 0.0014 coronary guidewire (PILOT, Abbott Vascular), predilated with two non-compliant balloon dilatation catheters, and finally, the PVL was engaged with a 3.0 mm × 12 mm Shockwave balloon (Shockwave Medical Inc, Santa Clara, California, USA). Intravascular lithotripsy (IVL) application to this highly calcified leak and the increased support provided by the stiff guidewire finally allowed the progression of the 6-Fr dedicated delivery sheath (ODS III) into the LV. A 5 mm square twist (ST) device (PLD, Occlutech, Helsingborg, Sweden) was successfully deployed within the leak and the final echocardiographic and angiographic control confirmed the effective PVL closure.DiscussionIn patients at high surgical risk with moderate to severe regurgitation after SE TAVI due to a hard-to-approach calcified long tract, an extra AA support loop is mandatory during percutaneous PVL closure. Furthermore, IVL application greatly facilitates the progression of the delivery sheath and occluder which is key to a successful procedure

Native Mitral Valve Endocarditis Caused by Neisseria elongata subsp. nitroreducens in a Patient with Marfan Syndrome: First Case in Italy and Review of the Literature

Neisseria elongata (NE) is an aerobic Gram-negative organism that constitutes part of the commensal human normal oropharyngeal flora. Although previously considered not to be pathogenic, it has been recognized as an occasional cause of significant infections in humans. We report here the first case in Italy of infective endocarditis of a native prolapsing mitral valve in a patient with Marfan syndrome, caused by NE subspecies nitroreducens which has been rarely isolated from clinical specimens. The culprit organism has been confirmed by mass spectrometry directly from the positive blood culture, as previously reported. The amplified gene has been deposited in GenBank under accession number KT591873. In spite of the reported aggressive nature of NE, clinical remission was promptly obtained, there being no requirement for surgery

Dyslipidemia management with medical nutrition therapy: current status and perspectives

In Italy, patients with dyslipidennia account for 15-20% of the adult population with major healthcare and socio-economic impact. According to the ESC/EAS guidelines for the management of dyslipidemias, desirable cholesterol and triglyceride levels can be achieved with a synergy between drug treatment and adequate diet therapy. However, what diets should be adopted? In this review article, different types of dietary treatments are compared, with a special focus on diet education. The new scientific frontier of nutrigenetics is also discussed

Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience

Introduction: The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. Methods: Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound–Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. Results: Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16–63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea–orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10–45 min) and the mean procedural time was 55 ± 20 min (range = 35–90 min). The total occlusion rate at follow-up (mean 50 months, range 3–100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. Conclusions: The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life

CRT-724 Can the Aortic Wall Communicate with Us?

bjective: Association between aortic aneurysm wall and risk of rupture or dissection. Methods: Aortic specimens were obtained from 73 patients (51 men and 22 women, whose median age 61.7` 10.7 years) undergoing surgical repair of thoracic ascending aneurysm (TAA). Histopathological and immunohistochemical analyses were per- formed using adequate tissue specimens, appropriate techniques and criteria. Furthermore, genetic risk factors were also investigated. Results: We identified three phenotypes of TAAs with different quality of aortic wall at the time of operation: phenotype I (normal wall); phenotype II (moderate wall thickness); phenotype III (thin and weak wall). No significant differences were detected in term of demographic and clinical data, co-morbidity conditions and pharmacological treatments. In contrast, significant statistical differences were observed by comparing abnormalities of extracellular matrix components among three phenotypes (fibrosis p<0.005; elastic fragmentation p1⁄40.002; medionecrosis p1⁄40.004; cystic necrosis p1⁄40.07; apoptosis p<0.0001; MMP-9 amount p1⁄40.004). In addition, significant differences both in genotype distributions and allele frequencies were observed for following SNPs (Single Nucleotide Polymorphism): -1562C/T MMP-9 (Metalloproteinases-9), -786T/C eNOs (endothelial Nitric Oxide Synthase) and D/I ACE (Angiotensin Converting Enzyme). Conclusion: Aneurysm with thin and weak wall at the time of operation should seem genetically and mainly associated with extracellular matrix disorders of aorta wall and consequently with aorta aneurysm complications (rupture and dissection)

Is the Serum N Terminal Pro-Brain Natriuretic Peptide the Best Candidate Biomarker for Long-term Prognosis in Patients with Prosthesis-patient Mismatch after Mitral Valve Replacement?

AGE8. Is the Serum N Terminal Pro-Brain Natriuretic Peptide the Best Candidate Biomarker for Long-term Prognosis in Patients with Prosthesis-patient Mismatch after Mitral Valve Replacement? C. R. Balistreri1, C. Pisano1, R. Franchino1, S.R. Vacirca1, F. Crapanzano1, O. F. Triolo1, C. Palmeri1, G. Ruvolo1 1University Of Palermo, Palermo, Italy Background: Natriuretic peptides (NPs) are released from the heart in response to pressure and volume overload. Among these, B-NP and Nterminal- proBNP (NT-proBNP) have become important diagnostic tools for the management of heart failure. However, B-NP and NT-proBNP levels reflect complications of systolic and diastolic function as well as alteration of right ventricular and valvular function. In addition, their serum levels have a prognostic value in multiple clinical settings. Based on these observations, we sought to evaluate the relationship between prosthesis patient mismatch (PPM) and serum NT-pro-BNP levels after mitral valve replacement (MVR). PPM following MVR has been less investigated and it seems to mediate deleterious effects on long-term survival, even if contrasting opinions and data exist in the literature. Methods: A total of 100 patients that have undergone this surgical treatment will be enrolled, and opportune clinical data and peripheral blood samples will be collected. Blood samples are utilized to analyze clinical conditions and serum NT-proBNP levels. Evaluation of hemodynamic performances before or under dobutamine infusion is also being assessed. Results: The preliminary data on the serum NT-proBNP levels obtained seem to be interesting and promising, as well as their correlations with hemodynamic performances. Conclusions: The demonstration of negative effects on tricuspid valve and pulmonary hypertension and consequently on survival induced by PPM after MVR through the serum quantification of NT-proBNP levels might lead to consider it as an optimal biomarker to evaluate patients’ long-term prognosis and optimize surgical recommendations (i.e. tricuspid valve repair during mitral valve surgery in patients with moderate-severe mismatch)