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Electrochemotherapy and heart function:Treatment in a patient with implantable cardioverter defibrillator/pacemaker

World Journal of Anesthesiology 2013年第2期2卷 14-17页

作者： Maurizio Marandola Alida Albante Raffaele Quaglione Claudia Lucci Matteo Chiaretti Luigi Tritapepe department of Cardiovascular RespiratoryNephrologicAnesthesiologic and Geriatric Sciences"Sapienza" UniversityPoliclinico Umberto I00161 RomeItaly department of heart and great vessels " a.reale" "Sapienza" UniversityPoliclinico Umberto I00161 RomeItaly

Electrochemotherapy(ECT) is a recently described therapy that relies on the permeation of cancer cell membranes by electrical pulses to enhance cytotoxic drug penetration. It has been successfully used in the treatment of primary and metastatic skin cancer. Systemic chemotherapy is the most commonly used therapeutic strategy, and the prevailing orientation calls for the administration of the maximum tolerated dose; however, considerable limitations exist including toxicities to healthy tissues and low achievable drug concentrations at tumor sites. We reported a case of an 83-years-old patient with a laterocervical metastasis of a squamous epidermoidal lip cancer. The patient had a complex medical history and an implantable cardioverter defibrillator(ICD)/pace-maker. The lesion was localized in the supraclavicular right side with a distance from the pace-maker/ICD about 5 cm, but the nodule was not deeply located. The ECT was performed un-der general anesthesia and particular attention we put on the interference with the functioning of the heart. The synchronization algorithm currently implemented in Clinoporator Vitae device coupled with the external triggering device Accu Sync proved to be effective in preventing external stimulation of the heart during the so-called vulnerable period of the ventricles. As a result all electroporation pulses in our study were delivered outside the vulnerable period and no heart arrhythmias or any other pathological morphological changes were observed. The safety of treatment was demonstrated also by absence of side effects during and after ECT.

关键词： General anesthesia Electrochemotherapy Pace-maker Implantable cardioverter defibrillator Tumor ablation Metastatic skin cancer

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Clinical application of individualized total arterial coronary artery bypass grafting in coronary artery surgery

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World Journal of Clinical Cases 2021年第19期9卷 5073-5081页

作者： Wei-Guang Chen Bai-Chun Wang Yong-Ri Jiang Ye-Yang Wang Yang Lou Second Ward Department of Heart and Great Arteries SurgeryFourth Affiliated Hospital of Harbin Medical UniversityHarbin 150001Heilongjiang ProvinceChina

BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often *** study determined whether these favorable clinical results could be realized at the authors’*** To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting *** CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December *** was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 *** complications were observed,short-term graft patency rate was followed-up,and quality of life was *** All patients underwent off-pump coronary artery bypass and the surgeries were *** of them were discharged without any complications or *** the follow-up,it was found that patients’angina symptoms were relieved and New York heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for *** The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.

关键词： Total arterial revascularization Coronary artery bypass grafting Radial artery Right gastroepiploic artery

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Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial

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World Journal of Gastroenterology 2006年第9期12卷 1403-1407页

作者： Roberto Giulio Romanelli Giorgio La Villa Giuseppe Barletta Francesco Vizzutti Fabio Lanini Umberto Arena Vieri Boddi Roberto Tarquini Pietro Pantaleo Paolo Gentilini Giacomo Laffi department of Internal Medicine University of Florence School of Medicine FlorenceItaly department of heart and vessels University of Florence School of Medicine FlorenceItaly department of Public Health University of Florence School of Medicine FlorenceItaly Giacomo Laffi department of Internal Medicine University of Florence School of Medicine Florence Italy

AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter （group 1） or diuretics alone （group 2）. The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications. RESULTS： Median follow-up was 84 （2-120） mo. Albu- min-treated patients had significantly greater cumulative survival rate （Breslow test= 7.05, P= 0.0078） and lower probability of ascites recurrence （51% versus 94%, P〈0.0001）. Chronic albumin infusion resulted in a mean increase in survival of 16 mo. CONCLUSION： Long-term albumin administration after first-onset ascites significantly improves patients＇ survival and decreases the risk of ascites recurrence.

关键词： Long-term albumin administration after first-onset ascites significantly improves patients' survival and decreases the risk of ascites recurrence.

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Reduction of radiation exposure in catheter ablation of atrial fibrillation: Lesson learned

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World Journal of Cardiology 2015年第8期7卷 442-448页

作者： Roberto De Ponti department of heart and vessels Ospedale di Circolo e Fondazone Macchi University of Insubria

Over the last decades, the concern for the radiation injury hazard to the patients and the professional staff has increased in the medical community. Since there is no magnitude of radiation exposure that is known to be completely safe, the use of ionizing radiation during medical diagnostic or interventional procedures should be as low as reasonably achievable(ALARA principle). Nevertheless, in cardiovascular medicine, radiation exposure for coronary percutaneous interventions or catheter ablation of cardiac arrhythmias may be high: for ablation of a complex arrhythmia, such as atrial fibrillation, the mean dose can be > 15 m Sv and in some cases > 50 m Sv. In interventional electrophysiology, although fluoroscopy has been widely used since the beginning to navigate catheters in the heart and the vessels and to monitor their position, the procedure is not based on fluoroscopic imaging. Therefore, nonfluoroscopic three-dimensional systems can be used to navigate electrophysiology catheters in the heart with no or minimal use of fluoroscopy. Although zerofluoroscopy procedures are feasible in limited series, there may be difficulties in using no fluoroscopy on a routine basis. Currently, a significant reduction in radiation exposure towards near zero-fluoroscopy procedures seems a simpler task to achieve, especially in ablation of complex arrhythmias, such as atrial fibrillation. The data reported in the literature suggest the following three considerations. First, the use of the non-fluoroscopic systems is associated with a consistent reduction in radiation exposure in multiple centers: the more sophisticated and reliable this technology is, the higher the reduction in radiation exposure. Second, the use of these systems does not automatically lead to reduction of radiation exposure, but an optimized workflow should be developed and adopted for a safe non-fluoroscopic navigation of catheters. Third, at any level of expertise, there is a specific learning curve for t

关键词： Catheter ablation Atrial fibrillation Radiation exposure Fluoroscopy time Dose area product Electro-anatomic mapping

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Role of catheter ablation of ventricular tachycardia associated with structural heart disease

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World Journal of Cardiology 2011年第11期3卷 339-350页

作者： Roberto De Ponti department of heart Brain and Vessels Ospedale di Circolo e Fondazione Macchi University of Insubria

In patients with structural heart disease, ventricular tachycardia (VT) worsens the clinical condition and may severely affect the shortand long-term prognosis. Several therapeutic options can be considered for the management of this arrhythmia. Among others, catheter ablation, a closed-chest therapy, can prevent arrhythmia recurrences by abolishing the arrhythmogenic substrate. Over the last two decades, different techniques have been developed for an effective approach to both tolerated and untolerated VTs. The clinical outcome of patients undergoing ablation has been evaluated in multiple studies. This editorial gives an overview of the role, methodology, clinical outcome and innovative approaches in catheter ablation of VT.

关键词： Catheter ablation Electroanatomic mapping Implantable cardioverter-defibrillator Radio-frequency energy Sudden cardiac death Ventricular tachycardia

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Assessment of platelet function: Laboratory and point-of-care methods

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World Journal of Translational Medicine 2014年第2期3卷 69-83页

作者： Rita Paniccia Raffaella Priora Agatina Alessandrello Liotta Niccolò Maggini Rosanna Abbate department of Experimental and Clinical Medicine Thrombosis Center University of Florence department of heart and vessels Azienda Ospedaliero-Universitaria Careggi

In the event of blood vessel damage, human platelets are promptly recruited on the site of injury and, after their adhesion, activation and aggregation, prevent blood loss with the formation of a clot. The consequence of abnormal regulation can be either hemorrhage or the development of thrombosis. Qualitative and/or quantitative defects in platelets promote bleeding, whereas the residual reactivity of platelets, despite antiplatelet therapies, play an important role in promoting arterial thrombotic complications. Platelet function is traditionally assessed to investigate the origin of a bleeding syndrome, to predict the risk of bleeding prior surgery or during pregnancy or to monitor the efficacy of antiplatelet therapy in thrombotic syndromes that, now, can be considered a new discipline. "Old" platelet function laboratory tests such as the evaluation of bleeding time and the platelet aggregation analysis inplatelet-rich plasma are traditionally utilized to aid in the diagnosis and management of patients with platelet and hemostatic disorders and used as diagnostic tools both in bleeding and thrombotic diathesis in specialized laboratories. Now, new and renewed automated systems have been introduced to provide a simple, rapid assessment of platelet function including point of care methods. These new methodologies are also suitable for being used in non-specialized laboratories and in critical area for assessing platelet function in whole blood without the requirement of sample processing. Some of these methods are also beginning to be incorporated into routine clinical use and can be utilized as not only as first panel for the diagnosis of platelet dysfunction, but also for monitoring anti-platelet therapy and to potentially assess risk of both bleeding and/or thrombosis.

关键词： Platelets Method Test Point of care testing Laboratory assessment Bleeding Thrombosis Platelet function

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Systemic venous atrium stimulation in transvenous pacing after mustard procedure

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World Journal of Cardiology 2014年第9期6卷 1041-1044页

作者： Calogero Puntrello Fabiana Lucà Gaspare Rubino Carmelo Massimiliano Rao Sandro Gelsomino department of Cardiology Paolo Borsellino Hospital department of Cardiology Melacrino Morelli Hospital department of heart and vessels Careggi Hospital

We present the case of a young woman corrected with a Mustard procedure undergoing successful transvenous double chamber pacemaker implantation with the atrial lead placed in the systemic venous channel. The case presented demonstrates that, when the systemic venous atrium is separate from the left atrial appendage, the lead can be easily and safely placed in the systemic venous left atrium gaining satisfactory sensing and pacing thresholds despite consisting partially of pericardial tissue.

关键词： Cardiac pacing Mustard procedure Trans-position of great arteries

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Risk Stratification and Prognosis of Pulmonary Arterial Hypertension Associated with Congenital heart Disease

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Congenital heart Disease 2024年第3期19卷 325-339页

作者： Wenjie Dong Zhibin Hong Aqian Wang Kaiyu Jiang Hai Zhu Fu zhang Zhaoxia Guo Hongling Su Yunshan Cao department of Cardiology The First People’s Hospital of TianshuiTianshui741000China department of Cardiology Pulmonary Vascular Disease CenterGansu Provincial HospitalLanzhou730000China heart Lung and Vessels CenterSichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu610072China

Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication ***,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further *** study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year ***,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD ***:This retrospective study included 126 PAH-CHD *** and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact ***-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these ***:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD *** activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of ***:The simplified risk stratification method is applicable to PAH-CHD *** activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.

关键词： Pulmonary hypertension pulmonary arterial hypertension congenital heart disease risk stratification

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Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders

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World Journal of Clinical Cases 2014年第7期2卷 257-264页

作者： Giovanni Castellini Walter Castellani Lorenzo Lelli Carolina Lo Sauro Carla Dini Lisa Lazzeretti Lorenza Bencini Edoardo Mannucci Valdo Ricca department of Neuroscience PsychologyDrug Research and Child HealthUniversity of Florence50134 FirenzeItaly department of Respiratory Physiopathology Palagi Hospital50134 FirenzeItaly department of Health Science University of Florence50134 FirenzeItaly Nutrition Service University of Florence50134 FirenzeItaly Non Invasive Cardiology Department of Heart and VesselsUniversity of Florence50134 FirenzeItaly

AIM: To investigate the complex relationships between resting energy expenditure(REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders. METHODS: The study was designed as a crosssectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence(Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clini-cal interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire(EDE-Q). Patients were also evaluated by means of the symptom checklist(SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated. RESULTS: Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index(BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels(mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating

关键词： Anorexia nervosa Bulimia nervosa Cortisol Psychopathology Resting energy expenditure

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Role of three-dimensional imaging integration in atrial fibrillation ablation

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World Journal of Cardiology 2010年第8期2卷 215-222页

作者： Roberto De Ponti Raffaella Marazzi Domenico Lumia Giuseppe Picciolo Roberto Biddau Carlo Fugazzola Jorge A Salerno-Uriarte department of heart Brain and VesselsOspedale di Circolo e Fondazione MacchiUniversity of Insubria department of Radiology Ospedale di Circolo e Fondazione MacchiUniversity of Insubria

Atrial fibrillation is the most common arrhythmia and in symptomatic patients with a drug-refractory form,catheter ablation aimed at electrically disconnecting the pulmonary veins(PVs) has proved more effective than use of antiarrhythmic drugs in maintaining sinus rhythm during *** the other hand,this ablation procedure is complex,requires specific training and adequate clinical experience.A main challenge is represented by the need for accurate sequential positioning of the ablation catheter around each veno-atrial junction to deliver point-by-point radiofrequency energy applications in order to achieve complete and persistent electrical disconnection of the *** integration is a new technology that enables guidance during this procedure by showing a three-dimensional,pre-acquired computed tomography or magnetic resonance image and the relative real-time position of the ablation catheter on the screen of the electroanatomic *** in the literature suggest that imaging integration provides accurate visual information with improvement in the procedure parameters and/or clinical outcomes of the procedure.

关键词： Catheter ablation Atrial fibrillation Electroanatomic mapping Multislice computed tomography Magnetic resonance imaging

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