Dott. Marianeschi Stefano
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A case of parvovirus B19-associated fulminant myocarditis in an infant successfully treated with immunosuppressive therapy.
J Cardiovasc Med (Hagerstown)2022 Oct;23(10):697-699. doi: 10.2459/JCM.0000000000001358.
Veronese Giacomo, Nonini Sandra, Bottiroli Maurizio, Annoni Giuseppe, Izzo Francesca, Nespoli Luisa F, Corato Alessandra, Marianeschi Stefano M, Aresta Francesca, Bramerio Manuela A, Mondino Michele, Ammirati Enrico
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Enterovirus fulminant myocarditis as cause of acute heart failure in a newborn.
Int J Cardiol Heart Vasc2022 Oct;42():101093. doi: 101093.
Annoni Giuseppe, De Rienzo Francesca, Nonini Sandra, Pugni Lorenza, Marianeschi Stefano M, Mauri Luigi, Gatelli Italo, Mauri Lucia, Aresta Francesca, Bramerio Manuela, Francescato Gaia, Carro Cristina, Picciolli Irene, Nava Alice, Fanti Diana, Galli Cristina, Mosca Fabio, Martinelli Stefano, Ammirati Enrico
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Cor Triatriatum Dexter: Contrast Echocardiography Is Key to the Diagnosis of a Rare but Treatable Cause of Neonatal Persistent Cyanosis.
Children (Basel)2022 May;9(5):. doi: 676.
Picciolli Irene, Francescato Gaia, Colli Anna Maria, Cappelleri Alessia, Mayer Alessandra, Raschetti Roberto, Di Cosola Roberta, Pisaniello Marco, Annoni Giuseppe Alberto, Papa Marco, Maldi Mimoza, Olivieri Guido, Mosca Fabio, Marianeschi Stefano
Abstract
Cor triatriatum dexter (CTD) is an extremely uncommon and underreported congenital cardiac anomaly in which the persistence of the embryonic right venous valve separates the right atrium into two chambers with varying degrees of obstruction to antegrade flow and variable degree of right to left shunt at atrial level. Depending on the size of the valves, clinical manifestations vary from absence of symptoms to severe hypoxia, requiring urgent surgical correction. We herein describe the diagnostic difficulties in a case of neonatal CTD, who developed increasingly severe and unresponsive cyanosis, first interpreted as postnatal maladjustment with pulmonary hypertension. The failure to respond to oxygen and pulmonary vasodilators led us to reconsider a different diagnosis. The use of contrast echocardiography improved the diagnostic performance of transthoracic echocardiogram (TTE) and revealed a massive right-to-left shunt secondary to the presence of an atrial membrane that required urgent surgery.
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Mission Bambini and the "Children's Heart Program": The Challenge of Congenital Heart Disease Among Emergency and Education.
Front Pediatr2021 ;9():705607. doi: 705607.
Marianeschi Stefano M, Albano Giulia, Viola Nicola, Barenghi Alberto, Gusella Alex
Abstract
Congenital heart disease is defined as abnormality in the cardiovascular structure or function that is present at birth and it is the most common cause of congenital anomalies. Approximately 90% of more than 1,000,000 children born per year with congenital heart disease worldwide receive suboptimal care or have no access to care at all. Furthermore, the mortality is likely underreported in Low-and Middle-Income Countries. Mission Bambini Foundation is an Italian NGO founded in 2000, aiming at "helping and supporting children who are poor, sick, without education or physically and morally abused" in Italy and worldwide. In 20 years, through 1.700 projects, 1.4 million children have been supported in 75 Countries. In 2005, Mission Bambini launched the "Children's Heart Program," based on long-term partnerships and on medical/surgical volunteering, in order to provide multidisciplinary education and training and technical support.
Copyright © 2022 Marianeschi, Albano, Viola, Barenghi and Gusella.
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Analysis of a Cooperation and Interventional Model in Humanitarian Medicine.
Front Pediatr2021 ;9():705149. doi: 705149.
Marianeschi Stefano M, Uricchio Nicola, Cerri Gianandrea Bern, Ghiselli Simone, Carro Cristina, Albano Giulia, Viola Nicola
Abstract
Every year, around 15 million children, in developing countries, die or develop life-long disabilities because of congenital cardiac diseases. In this report we measure the effect of a pediatric cardiac surgery humanitarian project on the health of the individual and on the potential influence this has on the countries economy and its growing health services. We collected and analyzed data from the Italian NGO, Mission Bambini's database, including all congenital cardiac missions undertaken in Cambodia between 2012 and 2019. DALY's (Disability Adjusted Life Years) saved by the humanitarian mission were estimated and used to reflect on the impact this had on the populations economy. Progression in the local medical teams skills emulated the advancements made in the health sector of the region. Between 2012 and 2019, 128 patients underwent a congenital cardiac operation at Angkor Hospital for Children at Siem Reap, Cambodia. The median age was 6 years. The majority of the pathologies included VSD, TOF, ASD. The mean Aristotle's Complexity Score was 6. Post-operative mortality was 0.8% (1/128). The cost-effectiveness analysis identified 5.360 DALY's saved by surgery. The competency of the local team was progressive with them being able to handle more complex cases on subsequent missions. In developing Countries, performing congenital cardiac surgery cases can be carried out successfully with improvement in both the economy and the health system of the country by increasing the years and the quality of life of the working population and developing the expertise of the regional team.
Copyright © 2021 Marianeschi, Uricchio, Cerri, Ghiselli, Carro, Albano and Viola.
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An alternative valve for mitral valve replacement in young children: using an NO-REACT® INJECTABLE BIOPULMONIC? prosthesis as a mitral valve replacement in a 14-month-old child.
Interact Cardiovasc Thorac Surg2022 Jun;34(6):1168-1170. doi: 10.1093/icvts/ivab274.
Carro Cristina, Marianeschi Stefano, Ghiselli Simone, Uricchio Nicola
Abstract
Mitral valve replacement in infants is challenging and there are limited alternative valves available. Since the Boston group published their first report on alternative valves for mitral valve replacement in infants, there has been a growth in the literature on the topic, mostly based on the use of a stented bovine jugular vein graft (Melody® valve). The challenges of the Melody valve are firstly in its length of 28?mm unexpanded, which has the potential to cause left ventricular outflow tract obstruction, and secondly, the valve needs mechanical dilatation, which is laborious. A modified No-React® Injectable Biopulmonic? Prosthesis (Bio Integral Surgical, Inc., Mississauga, ON, Canada) which is shorter (19?mm) and simpler in that it is self-expanding was implanted in a 14-month-old child to replace her mitral valve. The operation was successful and the short-term function of the prosthesis is good.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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Impact of COVID-19 Pandemic on the Italian Humanitarian Congenital Cardiac Surgery Activity: What No One Tells You.
Front Cardiovasc Med2021 ;8():705029. doi: 705029.
Giamberti Alessandro, Caldaroni Federica, Varrica Alessandro, Pace Napoleone Carlo, Marianeschi Stefano Maria, Uricchio Nicola, Vanini Vittorio, Santoro Francesco, Luciani Giovanni Battista, Stellin Giovanni, Gargiulo Gaetano, Murzi Bruno, Filippelli Sergio, Oppido Guido, Agati Salvatore, Galletti Lorenzo, Frigiola Alessandro
Abstract
More than 4 millions of children with congenital heart disease (CHD) are waiting for cardiac surgery around the world. Few of these patients are treated only thanks to the support of many non-governmental organizations (NGOs). Starting in December 2019, the so-called coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic and has dramatically impacted on all the international humanitarian activities for congenital heart disease. We analyzed data from all the Italian congenital cardiac surgery centers with the aim to quantify the impact of the pandemic on their charities. Fifteen Italian centers participated in the study and contributed to data collection. We analyzed and compared data regarding humanitarian activities carried out abroad and on site from two periods: year 2019 (pre-COVID-19) and year 2020 (COVID-19 pandemic). In 2019, 53 international missions were carried out by Italian congenital cardiac surgeons, resulting in the treatment of 471 CHD patients. In the same period 11 Italian cardiac centers operated on 251 foreign patients in Italy. In 2020, the pandemic led to a reduction of this activity by 96% for the surgery performed overseas and 86% for the interventions carried out in Italy. In conclusion our study shows the important quantitative impact of the pandemic on the Italian humanitarian cardiac surgical activity overseas and in Italy. This shocking result highlights the failure of the systems adopted so far to solve the problem of CHD in developing countries.
Copyright © 2021 Giamberti, Caldaroni, Varrica, Pace Napoleone, Marianeschi, Uricchio, Vanini, Santoro, Luciani, Stellin, Gargiulo, Murzi, Filippelli, Oppido, Agati, Galletti and Frigiola.
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Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve.
Eur J Cardiothorac Surg2020 Nov;():. doi: ezaa337.
Ghiselli Simone, Carro Cristina, Uricchio Nicola, Annoni Giuseppe, Marianeschi Stefano M
Abstract
OBJECTIVES:
Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device.
METHODS:
From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7?years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects.
RESULTS:
Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8?years (2?months-12.7?years); 42% of the patients were followed for more than 5?years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV.
CONCLUSIONS:
An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Impact of the coronavirus disease 2019 (COVID-19) pandemic on the Italian congenital cardiac surgery system: a national survey.
Eur J Cardiothorac Surg2020 Dec;58(6):1254-1260. doi: 10.1093/ejcts/ezaa352.
Giamberti Alessandro, Varrica Alessandro, Agati Salvatore, Gargiulo Gaetano, Luciani Giovanni Battista, Marianeschi Stefano Maria, Pace Napoleone Carlo, Oppido Guido, Brunelli Federico, Palma Gaetano, Pak Vitali, Arcieri Luigi, Scalzo Gabriele, Padalino Massimo, Galletti Lorenzo,
Abstract
OBJECTIVES:
Italy has been one of the countries most severely affected by the coronavirus disease 2019 (COVID-19). The Italian government was forced to introduce quarantine measures quickly, and all elective health services were stopped or postponed. This emergency has dramatically changed the management of paediatric and adult patients with congenital heart disease. We analysed data from 14 Italian congenital cardiac surgery centres during lockdown, focusing on the impact of the pandemic on surgical activity, patients and healthcare providers and resource allocation.
METHODS:
Fourteen centres participated in this study. The period analysed was from 9 March to 4 May. We collected data on the involvement of the hospitals in the treatment of patients with COVID-19 and on limitations on regular activity and on the contagion among patients and healthcare providers.
RESULTS:
Four hospitals (29%) remained COVID-19 free, whereas 10 had a 39% reduction in the number of beds for surgical patients, especially in the northern area. Two hundred sixty-three surgical procedures were performed: 20% elective, 62% urgent, 10% emergency and 3% life-saving. Hospital mortality was 0.4%. Compared to 2019, the reduction in surgical activity was 52%. No patients operated on had positive test results before surgery for severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19. Three patients were infected during the postoperative period. Twenty-nine nurses and 12 doctors were infected. Overall, 80% of our infected healthcare providers were in northern centres.
CONCLUSIONS:
Our study shows that the pandemic had a different impact on the various Italian congenital cardiac surgery centres based on the different patterns of spread of the virus across the country. During the lockdown, the system was able to satisfy all emergency clinical needs with excellent results.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Switch from minimally invasive biventricular mechanical support to cardiopulmonary bypass during heart transplant.
Eur J Cardiothorac Surg2021 Jan;59(1):271-273. doi: 10.1093/ejcts/ezaa343.
Settepani Fabrizio, Marianeschi Stefano Maria, Costetti Alessandro, Russo Claudio Francesco
Abstract
An easily reproducible surgical technique to switch from percutaneous minimally invasive biventricular mechanical support to cardiopulmonary bypass during heart transplantation is illustrated. After cannulation of the distal ascending aorta with a standard arterial cannula, the ProtekDuo® cannula and the ProtekSolo® Transseptal cannula were partially retracted to reach the superior and inferior vena cava, respectively, and connected to the pump circuit for the venous drainage. With this cardiopulmonary bypass configuration, orthotopic heart transplantation was routinely performed and, at the end of the procedure, the 2 cannulas were uneventfully removed.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Lombardy regional urgent reorganization for congenital cardiac patients following the Covid-19 pandemic.
J Cardiovasc Med (Hagerstown)2020 Sep;21(9):654-659. doi: 10.2459/JCM.0000000000001055.
Chessa Massimo, Varrica Alessandro, Andronache Andreea, Carminati Mario, Colli Anna Maria, D'Aiello Angelo Fabio, Ferrero Paolo, Mannarino Savina, Marcora Simona, Marianeschi Stefano Maria, Micheletti Angelo, Piazza Luciane, Saracino Antonio, Uricchio Nicola, Vignati Gabriele, Giamberti Alessandro
Abstract
OBJECTIVE:
By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization.
METHODS:
We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period.
RESULTS:
From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home.
CONCLUSION:
Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.
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Cangrelor use in a 6-year-old patient undergoing complex percutaneous coronary intervention after post-surgical myocardial infarction.
Platelets2020 Nov;31(8):1090-1093. doi: 10.1080/09537104.2020.1732323.
Sirico Domenico, Morici Nuccia, Soriano Francesco, Marianeschi Stefano Maria, Pedrazzini Giovanna, Leonardi Sergio, Vignati Gabriele
Abstract
Cangrelor is an intravenously administered P2Y receptor antagonist, which has been approved for adult patients undergoing percutaneous coronary intervention and, due to its unique pharmacokinetics, it allows effective and controllable peri-procedural platelet inhibition. We report the case of a 6-year-old child with anomalous origin of right coronary artery from aortic left coronary sinus, who underwent elective surgical replacement of stenotic and calcified conduit between the right ventricle and the main pulmonary artery. The surgery was complicated by acute myocardial infarction secondary to coronary extrinsic compression. The patient was successfully treated with urgent percutaneous coronary intervention (simultaneous V-stenting) and cangrelor infusion, subsequently switched to clopidogrel therapy.
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The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study.
Eur J Cardiothorac Surg2020 Mar;57(3):565-573. doi: 10.1093/ejcts/ezz270.
Padalino Massimo A, Pradegan Nicola, Azzolina Danila, Galletti Lorenzo, Pace Napoleone Carlo, Agati Salvatore, Palma Gaetano, Marianeschi Stefano Maria, Seddio Francesco, Cascarano Maria Teresa, Carro Cristina, Gregori Dario, Vida Vladimiro Lorenzo, Stellin Giovanni
Abstract
OBJECTIVES:
Repair of Tetralogy of Fallot (TOF) has currently excellent results with either transventricular or transatrial approach. However, it is unclear as to which has better late outcomes and what role of residual pulmonary valve (PV) regurgitation in the long term is. We report on late clinical outcomes after repair in a large series of patients with TOF, focusing on the type of surgical technique.
METHODS:
This analysis is a retrospective multicentre study on patients undergoing TOF repair in infancy. The exclusion criteria of the study were TOF with pulmonary atresia or absent PV.
RESULTS:
We selected 720 patients who had undergone TOF repair (median age 5.7?months, interquartile range 3.7-11.7). Preoperative cyanotic spells occurred in 18%. A transatrial repair was performed in 433 (60.1%) patients. The PV was preserved in 249 (35%) patients, while the right ventricular outflow tract was reconstructed with a transannular patch (60.4%) or a conduit (4.6%) in the rest of the patients. At a median follow-up of 4?years (range 1-21, 86% complete), 10 (1.6%) patients died, while 39 (6.3%) patients required surgical reoperation and 72 (11.7%) patients required an interventional procedure. The propensity match analysis showed that the incidence of postoperative complications and adverse events at follow-up were significantly increased in patients undergoing transventricular approach repair with transannular patch (P?=?0.006) and PV preservation was a significant protective factor against postoperative complications (P?=?0.009, odds ratio 0.5) and late adverse events (P?=?0.022).
CONCLUSIONS:
Surgical repair of TOF in infancy is a safe procedure, with good late clinical outcomes. However, transatrial approach and PV preservation at repair are associated with lower early and late morbidity.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub-Saharan experience.
J Card Surg2019 Dec;34(12):1478-1485. doi: 10.1111/jocs.14270.
Tefera Endale, Gedlu Etsegenet, Nega Berhanu, Tadesse Birkneh T, Chanie Yilkal, Dawoud Ali, Moges Fekadesilassie H, Bezabih Abebe, Moges Tamirat, Centella Tomasa, Marianeschi Stefano, Coca Ana, Collado Raquel, Kassa Mamo W, Johansson Sune, van Doorn Carin, Barber Brent J, Teodori Michael
Abstract
BACKGROUND:
Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams.
METHODS:
We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality.
RESULTS:
During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P?.001), repeated runs and long cardiopulmonary bypass time (P?.001), and aortic cross-clamp time (P?.001), narrow pulmonary artery (PA) valve annulus diameter (P?=?.022), narrow distal main PA diameter (P?=?.039), narrow left branch PA diameter (P?=?.049), and narrow right PA diameter (P?=?.039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality.
CONCLUSION:
In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention.
© 2019 Wiley Periodicals, Inc.
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Italian survey on cardiac surgery for adults with congenital heart disease: which surgery, where and by whom?
Interact Cardiovasc Thorac Surg2019 Aug;29(2):260–265. doi: 10.1093/icvts/ivz045.
Giamberti Alessandro, Chessa Massimo, Chiarello Carmelina, Cipriani Adriano, Carotti Adriano, Galletti Lorenzo, Gargiulo Gaetano, Marianeschi Stefano Maria, Pace Napoleone Carlo, Padalino Massimo, Perri Gianluigi, Luciani Giovanni Battista
Abstract
OBJECTIVES:
The population of ageing adults with congenital heart disease (ACHD) is increasing; surgery in these patients presents major difficulties in management. A great debate has developed about whether these patients should be cared for at an adult or paediatric hospital and by an acquired or congenital cardiac surgeon. We analysed data of the surgical treatment of ACHD from the Italian cardiac surgery centres in 2016, focusing on the type of surgery performed, where these patients were operated on and by whom.
METHODS:
Ninety-two Italian cardiac surgery centres were contacted and 70 centres participated in this study. We collected data on the types of cardiac operations performed in congenital heart defect patients older than 18?years. In 2016, a total of 913 patients with ACHD were operated on: 440 by congenital cardiac surgeons (group I) in centres with paediatric and adult cardiac surgery units, and 473 by adult cardiac surgeons (group II) in centres with exclusively adult cardiac surgery units.
RESULTS:
Pathologies of the right ventricular outflow tract were the most frequent diseases treated in group I and pathologies of the left ventricular outflow tract in group II. Group I included more complex and heterogeneous cases than group II. Surgery for ACHD represented 12% of the activity of congenital cardiac surgeons and only 1% of the activity of adult cardiac surgeons.
CONCLUSIONS:
In Italy, ACHD patients are operated on both by congenital and adult cardiac surgeons. Congenital cardiac surgeons working in centres with both paediatric and adult cardiac surgery are more involved with ACHD patients and with more complex cases.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Epicardial cardioverter-defibrillator implantation in a 4-month-old infant bridged to heart transplantation.
Interact Cardiovasc Thorac Surg2017 Nov;25(5):832-833. doi: 10.1093/icvts/ivx129.
Carro Cristina, Cereda Alberto Francesco, Annoni Giuseppe, Marianeschi Stefano Maria
Abstract
Implantable cardioverter-defibrillator (ICD) is the gold standard therapy for the prevention of sudden cardiac death. Nevertheless, ICD placement in the paediatric population is still limited because of several technical difficulties. Several implantation techniques have been proposed but experience in infants with very low weight and less than 6?months is very limited. We herein describe a case of a minimally invasive ICD epicardial implantation in a 4-month-old infant weighing 5?kg. A diagnosis of arrhythmic cardiomyopathy with left ventricular non-compaction disease with ventricular tachycardia storms, QT prolongation and Wolff-Parkinson-White pattern was made. Antiarrhythmic drugs, radiofrequency ablation and sympathetic denervation were not effective. ICD implantation was successful allowing the infant to survive and bridging to heart transplantation.
© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Off-pump Kommerell's diverticulum resection and descending aorta replacement.
J Card Surg2016 Aug;31(8):544-5. doi: 10.1111/jocs.12794.
Nicolò Francesca, Costetti Alessandro, Carro Cristina, Marianeschi Stefano Maria
Abstract
We report the case of an unusual variation of a Kommerell's diverticulum in a left aortic arch with an aberrant left subclavian artery, associated with dilatation of the distal aortic arch, surgically treated without the use of extracorporeal circulation.
© 2016 Wiley Periodicals, Inc.
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Palliative Arterial Switch for Congenitally Corrected Transposition of the Great Arteries with Ventricular Septal Defect and Subaortic Hypoplasia.
J Card Surg2015 Dec;30(12):908-9. doi: 10.1111/jocs.12659.
Federici Duccio, Marianeschi Stefano, Marcora Simona, Galletti Lorenzo
Abstract
We present a case of palliative arterial switch with aortic arch reconstruction performed as the first stage of anatomical correction in a patient with congenitally corrected transposition of great arteries (ccTGA), ventricular septal defect (VSD), duct-dependent aortic coartation, and hypoplasia of the ascending aorta and subaortic tract.
© 2015 Wiley Periodicals, Inc.
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Outcome in Children Operated for Membranous Subaortic Stenosis: Membrane Resection Plus Aggressive Septal Myectomy Versus Membrane Resection Alone.
World J Pediatr Congenit Heart Surg2015 Jul;6(3):424-8. doi: 10.1177/2150135115589789.
Tefera Endale, Gedlu Etsegenet, Bezabih Abebe, Moges Tamirat, Centella Tomasa, Marianeschi Stefano, Nega Berhanu, van Doorn Carin, Sasson Lior, Teodori Michael
Abstract
BACKGROUND:
The optimal surgical procedure for treatment of fibromembranous subaortic stenosis has been a subject of debate. We report our experience with patients treated for membranous subaortic stenosis using membrane resection alone and membrane resection plus aggressive septal myectomy.
METHODS:
Patients followed in the pediatric cardiology clinic of a university hospital, who had undergone surgery for subaortic stenosis between 2002 and 2013 were reviewed. Recurrence of subaortic membrane, residual left ventricular outflow gradient, and aortic valve function were analyzed.
RESULTS:
Forty-six patients underwent surgery for subaortic membrane. Of these, 19 had membrane resection plus aggressive septal myectomy, while 27 had membrane resection alone. Mean age at surgery for the membrane resection group was 7.7 ± 3.9 years and 10.9 ± 3.6 years for the membrane resection plus aggressive myectomy group. Preoperative subaortic gradient for the membrane resection group was 75.5 ± 26.7 mm Hg and 103.2 ± 39.7 mm Hg for the membrane resection plus aggressive myectomy group. The mean follow-up left ventricular outflow tract gradient was 42.3 ± 31.3 mm Hg in the membrane resection group, while it was 11.6 ± 6.3 mm Hg in the aggressive septal myectomy group. Nine patients from the membrane resection group had significant regrowth of the subaortic membrane during the follow-up period, while none of the aggressive septal myectomy group had detectable membrane on echocardiography. Seven of the nine patients with recurrence of the subaortic membrane underwent subsequent membrane resection plus aggressive septal myectomy. Intraoperative finding in all these redo cases was recurrence (growth) of a subaortic membrane.
CONCLUSION:
Aggressive septal myectomy offers less chance of recurrence, freedom from reoperation, and an improved aortic valve function. This is especially important in sub-Saharan settings where a chance of getting a second surgery is unpredictable.
© The Author(s) 2015.
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[A matter of perspective: multimodality imaging of a giant cardiac mass].
G Ital Cardiol (Rome)2015 Mar;16(3):186-7. doi: 10.1714/1820.19830.
Baroni Matteo, Nava Stefano, Vignati Gabriele, Marianeschi Stefano Maria, Giannattasio Cristina, Pedrotti Patrizia
Abstract
A newborn was suspected of having situs inversus with levocardia based on chest X-ray. Echocardiography ruled out this hypothesis but revealed a giant cardiac mass that was confirmed by magnetic resonance imaging. Coronary angiography showed that the right coronary artery ran on the surface of the mass, and only partial debulking surgery was performed to relieve right heart compression. Histological examination classified the mass as cardiac fibroma. Complex diagnostic work-up allowed correct anatomic definition of the mass as well as its relationship with adjacent structures, and helped guide surgical planning.
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[Transposition of the great arteries].
G Ital Cardiol (Rome)2015 Feb;16(2):92-9. doi: 10.1714/1798.19582.
Uricchio Nicola, Ghiselli Simone, Marianeschi Stefano Maria
Abstract
Dextro-transposition of the great arteries with intact ventricular septum (d-TGA) is the most frequent cyanotic congenital heart disease in neonates. In newborns affected by d-TGA, the pulmonary and systemic circulations are in parallel instead of being in series. The survival of babies affected by d-TGA is related to the level of mixing at the patent foramen ovale. The diagnosis of d-TGA is an indication for treatment due to scarce survival beyond the neonatal period if not corrected. The current surgical approach is the anatomical correction with the arterial switch operation, which has excellent early and medium-term results. In this review, we discuss treatment of d-TGA and the arterial switch operation, the medium- and long-term results following surgery, and the reasons that have led the arterial switch operation to its popularity compared to the former physiological correction of d-TGA, i.e. the Senning and Mustard procedures.
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Two decades of experience with the Ross operation in neonates, infants and children from the Italian Paediatric Ross Registry.
Heart2014 Dec;100(24):1954-9. doi: 10.1136/heartjnl-2014-305873.
Luciani Giovanni Battista, Lucchese Gianluca, Carotti Adriano, Brancaccio Gianluca, Abbruzzese Piero, Caianiello Giuseppe, Galletti Lorenzo, Gargiulo Gaetano Domenico, Marianeschi Stefano Maria, Mazzucco Alessandro, Faggian Giuseppe, Murzi Bruno, Pace Napoleone Carlo, Pozzi Marco, Zannini Lucio, Frigiola Alessandro
Abstract
OBJECTIVE:
Children undergoing Ross operation were expected to have longer autograft, but shorter homograft durability compared with adults. In order to define the outcome in the second decade after Ross operation in children, a nationwide review of 23?years of experience was undertaken.
METHODS:
305 children underwent Ross operation in 11 paediatric units between 1990 and 2012. Age at surgery was 9.4±5.7?years, indication aortic stenosis in 103 patients, regurgitation in 109 and mixed lesion in 93. 116 (38%) patients had prior procedures. Root replacement was performed in 201 patients, inclusion cylinder in 14, subcoronary grafting in 17 and Ross-Konno in 73.
RESULTS:
There were 10 (3.3%) hospital and 12 late deaths (median follow-up 8.7?years). Survival was 93±2% and 89±3% and freedom from any reoperation was 76±3% and 67±6% at 10 and 15?years. 34 children had autograft 37 reoperations (25 replacement, 12 repair): three required transplantation after reoperation. Freedom from autograft reoperation was 86±3% and 75±6% at 10 and 15?years. 32 children had right heart redo procedures, and only 25 (78%) conduit replacements (15-year freedom from replacement, 89±4%). Prior operation (p=0.031), subcoronary implant (p=0.025) and concomitant surgical procedure (p=0.004) were risk factors for left heart reoperation, while infant age (p=0.015) was for right heart. The majority (87%) of late survivors were in NYHA class I, 68% free from medication and six women had pregnancies.
CONCLUSIONS:
Despite low hospital risk and satisfactory late survival, paediatric Ross operation bears substantial valve-related morbidity in the first two decades. Contrary to expectation, autograft reoperation is more common than homograft.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Partial anomalous connection of both superior pulmonary veins.
Ann Thorac Surg2012 Aug;94(2):649-51. doi: 10.1016/j.athoracsur.2011.10.082.
Marianeschi Stefano M, Cannata Aldo, Uricchio Nicola, Pedretti Stefano, Vignati Gabriele
Abstract
Several patterns of anomalous pulmonary venous drainage have been described in the literature, and bilateral partial pulmonary anomalous vein connection (PAPVC) has been described as a rare congenital cardiac anomaly. We report an unusual type of bilateral PAPVC, involving both the superior right and left pulmonary veins draining into the left brachiocephalic vein in a young adult who was symptomatic with dyspnea and a dry cough.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Pulmonary valve implantation using self-expanding tissue valve without cardiopulmonary bypass reduces operation time and blood product use.
J Thorac Cardiovasc Surg2013 Apr;145(4):1040-1045. doi: 10.1016/j.jtcvs.2012.05.036.
Chen Qiang, Turner Mark, Caputo Massimo, Stoica Serban, Marianeschi Stefano, Parry Andrew
Abstract
OBJECTIVE:
The study objective was to review our initial experience with newly developed off-pump pulmonary valve implantation techniques and compare outcomes with the conventional approach.
METHODS:
Thirteen symptomatic patients with severe pulmonary regurgitation underwent pulmonary valve implantation, 6 without cardiopulmonary bypass (group 1: age, 28 ± 21 years; range, 12-62; body surface area range, 1.38-2.39 m(2)) and 7 with cardiopulmonary bypass (group 2: age, 23 ± 13 years; range, 10-46; body surface area range, 1.31-1.89 m(2)). Ten patients had previous repair of tetralogy of Fallot, and 3 patients had pulmonary valvotomy/valvuloplasty.
RESULTS:
Mean operation times were 166 minutes (range, 110-240) in group 1 and 299 minutes (range, 221-375) in group 2 (P
CONCLUSIONS:
Off-pump pulmonary valve implantation is a good alternative for pulmonary valve replacement. The procedure reduces operating time, blood loss, and blood product requirement.
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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Valvulopathies in sub-Saharan African children: patterns, humanitarian interventions and cardiac surgical problems.
Int J Cardiol2013 May;165(2):237-41. doi: 10.1016/j.ijcard.2012.03.069.
Ferratini Maurizio, Marianeschi Stefano, Santoro Francesco, Vitali Ettore, Ripamonti Vittorino, De Maria Renata, Torri Anna, Pezzano Antonio, Moraschi Andrea, Tavano Davide, Pesaresi Marilena, Martinelli Luigi
Abstract
Despite the high burden of rheumatic fever in sub-Saharan African, there is currently no sustained and comprehensive strategy to control the disease. Consequently in this area the number of patients affected by rheumatic valve disease (RVD), most with a surgical indication, is 10-20 fold higher than in industrialised countries and estimates indicate that more than 50% of African RVD patients will die before age 25. In this paper, we review clinical and management issues of RVD in children in sub-Saharan Africa. Severe heart failure and undergrowth are the prevalent presentation of the illness. Severe mitral regurgitation is the commonest rheumatic valvulopathy observed in the first and second decades. Valve repair, the approach of choice, may be associated with unfavourable outcomes in patients with extreme cardiomegaly. In young people, whenever correct anticoagulation may reasonably be achieved, mechanical mitral prostheses should be preferred, even in females. The early deterioration of biologic mitral prostheses strongly suggests limiting their use to those cases in which correct anticoagulation is not feasible. In most sub-Saharan countries, socioeconomic factors strongly limit access to health services and to cardiac surgery in particular. Efforts to overcome these barriers have resulted in humanitarian projects along two patterns: creation of high tech on site health care structures or transfer of children with complex diseases to receive highly specialised cardiac surgical care abroad. We summarise the experience of our programme that followed the latter approach.
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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Left arm underdevelopment secondary to an isolated left subclavian artery in tetralogy of Fallot.
Ann Thorac Surg2010 Feb;89(2):637-9. doi: 10.1016/j.athoracsur.2009.07.057.
Carnero Alcázar Manuel, Marianeschi Stefano, Ruiz Alonso Enrique, García Torres Enrique, Comas Juan V
Abstract
The anomalous origin of the left subclavian artery is known to be associated with right aortic arch and tetralogy of Fallot. In our case, the left subclavian artery arose from the left pulmonary artery. Therefore, the left arm was perfused by poorly oxygenated blood from pulmonary arteries and some retrograde vertebral artery flow. Thus, the left arm was cyanotic and less developed than the right one. The patient underwent surgical repair with complete correction of tetralogy of Fallot and reimplantation of the left subclavian artery to the left carotid artery.
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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Arterial-esophageal fistula: a severe complication in children with cardiovascular abnormalities.
Pediatr Surg Int2010 Mar;26(3):335-7. doi: 10.1007/s00383-009-2532-6.
Fuentes Sara, Cano Indalecio, López María, Moreno Cecilia, Tejedor Raquel, Marianeschi Stefano, García Enrique, Gómez Andrés
Abstract
Fistulae between esophagus and major arteries are an extremely rare and severe condition. They have been described in patients with previous impairment or abnormalities of mediastinal vessels and intraesophageal increased pressure or as a complication of cardiovascular procedures. We report three cases of children with an aorto-esophageal fistula, a collateral pulmonary artery-esophageal fistula and an aberrant right subclavian artery-esophageal fistula that were successfully managed in coordination with pediatricians, anesthesiologists and both cardiovascular and pediatric surgeons. The severity of this pathology makes it important to suspect it and treat it by a multidisciplinary group of physicians.
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Modification of the Norwood procedure in isomeric complete atrio-ventricular canal and hypoplastic right aortic arch.
J Cardiovasc Med (Hagerstown)2009 Jun;10(6):489-91. doi: 10.2459/JCM.0b013e3283272087.
García Enrique, Marianeschi Stefano M, Boni Lorenzo, Ramos Maria V, Jiménez Isabel, Berdat Pascal A, Comas Juan V
Abstract
We report a modification of the Norwood stage I procedure in a neonate with right aortic arch and complete atrio-ventricular canal in a variant of hypoplastic heart syndrome. Because of the unusual anatomy, the neo-aorta was reconstructed with a specially trimmed homograft patch and the pulmonary flow was maintained with implantation of a right ventricle to pulmonary artery shunt on the left side of the aorta. The patient had a favourable outcome and is now awaiting the stage II procedure.
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Current strategies in tetralogy of Fallot repair: pulmonary valve sparing and evolution of right ventricle/left ventricle pressures ratio.
Eur J Cardiothorac Surg2009 May;35(5):885-9; discussion 889-90. doi: 10.1016/j.ejcts.2009.01.016.
Boni Lorenzo, García Enrique, Galletti Lorenzo, Pérez Ana, Herrera Dolores, Ramos Victoria, Marianeschi Stefano M, Comas Juan V
Abstract
OBJECTIVE:
Chronic volume overload in repair of tetralogy of Fallot (TOF) with transannular patch leads to significant late morbidity and mortality. Preserving pulmonary valve integrity offers a better long-term prognosis, despite a risk of residual stenosis. In our study we analyzed the evolution of pressure gradients in patients operated with conservative approaches, with particular regard to those babies with an immediate postoperative Prv/Plv ratio >or=0.70.
METHODS:
Between January 2000 and June 2008, 24 patients with TOF underwent reparative surgery with a valve sparing procedure (median age 8.1 months, range 1.1-86.6). The intraoperative post-repair echocardiography showed a Prv/Plv ratio >or=0.70 in eight patients (33%, group A) and
RESULTS:
There was no early or late mortality, nor functional or rhythmic disturbances. One patient required re-operation for residual stenosis at annular level at one year. After a median follow-up of 32.8 months (range 0.6-73.1), the Prv/Plv ratio decreased by 16% (p=0.001) in all patients. In group A the reduction was 28% (p=0.018) and in group B it was 12% (p=0.14).
CONCLUSIONS:
After a valve sparing procedure there is a reduction of Prv/Plv ratio at medium-term follow-up; in our study this reduction was statistically significant in all patients and in the subgroup with higher postoperative ratios. A valve sparing strategy reduces pulmonary regurgitation, preserves RV function and decreases the incidence of late arrhythmias, which are the determinants of long-term outcome.
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Pulmonary valve implantation with the new Shelhigh Injectable Stented Pulmonic Valve.
Ann Thorac Surg2008 Nov;86(5):1466-71; discussion 1472. doi: 10.1016/j.athoracsur.2008.06.085.
Marianeschi Stefano M, Santoro Francesco, Ribera Elena, Catena Emanuele, Vignati Gabriele, Ghiselli Simone, Pedretti Stefano, Suleyman Ozkan, Ustunsoy Hasim, Berdat Pascal A
Abstract
BACKGROUND:
Pulmonary regurgitation (PR) occurs frequently after tetralogy of Fallot (TOF) repair, impairing long-term prognosis and necessitating reinterventions. Myocardial damage, invasiveness, and the risks of pulmonary valve replacement (PVR) therefore need to be minimized. The new Shelhigh Injectable Stented Pulmonic Valve (Shelhigh Inc, Union, NJ) allows implantation without cardiopulmonary bypass (CPB) under direct control.
METHODS:
Twelve symptomatic patients (age, 21.3 +/- 12.5; range, 5.8 to 53.5 years) with severe PR and progressive right ventricular (RV) dilatation with dysfunction received the Shelhigh valve in sizes 21 (n = 1), 25 (n = 4), 27 (n = 3), 29 (n = 2), and 31 mm (n = 2).
RESULTS:
Valve insertion was successful and hemodynamic performance excellent in all: peak systolic gradient, 14.5 +/- 4.6 (range, 10 to 20) mm Hg; mean gradient, 6.3 +/- 1.6 (range, 4 to 8) mm Hg. Four patients underwent concomitant procedures on CPB: one reduction plasty of a dilated main pulmonary artery, two tricuspid valve repairs, and one VSD closure. Early recovery was uneventful. There were no reoperations. During a mean follow-up of 5.4 +/- 4.3 months (range, 0.3 to 10.6 months) echocardiography showed good results, with low gradients and recovered RV function in all. All presented in New York Heart Association functional class 1 at the latest follow-up.
CONCLUSIONS:
The Shelhigh valve allows easy PVR without CPB up to large valve sizes, with less invasiveness compared with a conventional approach. Further follow-up is needed to assess its durability and long-term performance.
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Mechanical circulatory support for patients with fulminant myocarditis: the role of echocardiography to address diagnosis, choice of device, management, and recovery.
J Cardiothorac Vasc Anesth2009 Feb;23(1):87-94. doi: 10.1053/j.jvca.2008.03.008.
Catena Emanuele, Paino Roberto, Milazzo Filippo, Colombo Tiziano, Marianeschi Stefano, Lanfranconi Marco, Aresta Francesca, Bruschi Giuseppe, Russo Claudio, Vitali Ettore
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Surgical repair of left ventricle to coronary sinus fistula complicating mitral valve replacement.
J Cardiovasc Med (Hagerstown)2007 Oct;8(10):864-5.
Marianeschi Stefano Maria, Cannata Aldo, Catena Emanuele, Tarelli Giuseppe, Vitali Ettore
Abstract
We report the case of a 55-year-old female patient who underwent reoperation because of left ventricular to coronary sinus fistula following previous mitral valve replacement. The fistula was closed surgically with a patch of heterologous bovine pericardium. The postoperative course was uneventful and the patient is recovering well 12 months after the operation.
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[The project "Don Carlo Gnocchi Foundation--Cardio-Thoracic Department De Gasperis--Lombardy Region" for the care of children from socio-economically deprived areas affected by cardiac disease].
G Ital Cardiol (Rome)2007 Aug;8(8):519-26.
Ferratini Maurizio, Marianeschi Stefano, Vitali Ettore, Iorio Fiore, Moraschi Andrea, Pezzano Antonio, Mauri Luigi, Lorini Saverio, Rambaldi Roberto, Tersalvi Carlo Alberto, Pesaresi Marilena, Pllumi Arketa, Santoro Francesco
Abstract
BACKGROUND:
In 2001 the Cardiac Rehabilitation Unit IRCCS S. Maria Nascente Center and the International Area of Don Carlo Gnocchi Foundation, in collaboration with the Cardiac Surgery Department "De Gasperis" of Niguarda Ca' Granda Hospital in Milan, planned a project to treat children from impoverished countries. The "Fondo Sanitario Regionale" of the Lombard Region cosponsored the program.
METHODS:
From October 2001 to November 2006, 32 patients (25 from Zimbabwe and 7 from Albania) were selected and submitted to cardiac surgery: 22 patients were affected by acquired valvular heart disease in NYHA class III-IV, 10 by congenital heart disease. After surgery the patients admitted to our rehabilitation unit underwent a period of comprehensive cardiac rehabilitation. Afterwards, the patients were in the care of selected Italian families for about 3 months. In both populations the problems faced in the selection, management and surgical approach are discussed.
RESULTS:
At 21 months the survival of the whole study population was 93 % (2 valvular patients died during the follow-up); 2 patients who initially underwent mitral valve repair were submitted to valve replacement for late appearance of severe regurgitation. In 3 patients with mitral valve bioprosthesis a significant structural valve deterioration occurred in the follow-up and 2 of them underwent valve replacement.
CONCLUSIONS:
The advantage of the excellent performance in durability of mechanical prosthetic valves (with respect to the limited durability of porcine bioprostheses), the problems with long-term anticoagulation have to be taken into consideration in the management of patients coming from socio-economically deprived areas.
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