Papers by Gianfranco Butera
European Heart Journal, Aug 1, 2008
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The Journal of Invasive Cardiology, Jul 1, 2012
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La Pediatria medica e chirurgica: Medical and surgical pediatrics
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Minerva pediatrica
Pericardial diseases, in the pediatric age group are rare, and are usually due to viral infection... more Pericardial diseases, in the pediatric age group are rare, and are usually due to viral infection or collagen diseases. Since the advent of the antibiotic era, bacterial pericardial has rarely been reported, and the bacteria most commonly involved are Staphylococcus aureus, Streptococcus pneumoniae, Haemophylus influenzae and Neisseria meningitidis; other pyogenic agents have rarely been isolated in pericarditis. Gemella morbillorum, also known as Streptococcus morbillorum, is a Gram-positive pyogen, usually a saprophite agent of the human gastrointestinal tract, rarely associated with human infections such as arthritis, endocarditis and meningitidis; to our knowledge, it has never been isolated in pericarditis. We report a case of pyogenic pericarditis in an 11-year-old boy, suffering from substernal chest pain for about one year, in which the clinical symptoms, the presence of acute phase proteins, the large amount of fluid within the pericardial space (echocardiographically estimated to be approximately 18 mm), the lack of improvement in clinical conditions and in laboratory values after therapy (diuretics, broad spectrum antibiotics and steroids) led to the indication for a pericardial drainage with the isolation of Gemella morbillorum. Antimicrobial therapy was then modified according to in vitro susceptibility of the Gemella morbillorum, with a decisive contribution to the recovery of the patient, although long-term steroid therapy (5 months) was necessary because of one recurrence of pericardial effusion. This case report shows how Gemella morbillorum, usually a saprophit microorganism, can become pathogenic and also underlines the importance of a correct etiologic diagnosis of pericarditis resistent to classical antibiotic therapy.
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Italian heart journal: official journal of the Italian Federation of Cardiology
Pericardium patches are commonly used for the repair of congenital heart diseases. Aneurysmal dil... more Pericardium patches are commonly used for the repair of congenital heart diseases. Aneurysmal dilation is a complication specific to the use of pericardial patches. Preparation of the pericardium with glutharaldehyde is considered to avoid this risk. In the present case report, we describe the development of a giant aneurysm of a heterologous patch used for closure of a ventricular septal defect in a child aged 14 days.
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Archives des maladies du coeur et des vaisseaux
Transposition of the great arteries (TGA) is a common malformation which sometimes has a dramatic... more Transposition of the great arteries (TGA) is a common malformation which sometimes has a dramatic presentation at birth but which is completely curable with early and appropriate initial management. Antenatal diagnosis of this condition may change the neonatal prognosis. The authors compared morbidity and mortality in the pre- and postoperative periods of 68 neonates with an antenatal diagnosis of TGA (foetal diagnosis) with that of 250 neonates in whom the diagnosis was made after birth (neonatal diagnosis). The delay before admission to the department was 2 +/- 2.8 hours in the foetal group and 73 +/- 210 hours in the neonatal group (p < 0.01). Severe haemodynamic distress (metabolic acidosis, multi-organ failure) were more common in the neonatal group (p < 0.01). Management on admission was identical in the two groups (p > 0.05). The preoperative mortality was 15/250 in the neonatal group (6%, 95% CI = 3-9%) compared with 0/68 in the foetal group (p < 0.05). The postoperative morbidity was comparable in the two groups (25/235 and 6/68) but the hospital stay was longer in the neonatal group (30 +/- 17 versus 24 +/- 11 days, p < 0.01). Finally, postoperative mortality was significantly higher in the neonatal group (20/235 compared with 0/68, p < 0.01) although the risk factors of death at arterial switch surgery were identical in the two groups. Therefore, antenatal diagnosis of TGA reduces neonatal morbidity and mortality in this condition. Antenatal diagnosis must be developed by the education of obstetricians. The transfer of mothers with a foetus affected by TGA to centres capable of assuming the initial management, sometimes during labour, is essential.
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Herz
Background: To study heart rate variability (HRV) in patients operated for tetralogy of Fallot (T... more Background: To study heart rate variability (HRV) in patients operated for tetralogy of Fallot (ToF) and to identify any correlation between HRV and ventricular tachycardia (VT). Patients and Methods: We studied HRV in 23 consecutive patients operated for ToF (mean age 14 ± 6.6 years; mean follow-up 10.6 ± 5.2 years). Seven patients had non-sustained VT on Holter monitoring. Two
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Italian heart journal: official journal of the Italian Federation of Cardiology
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Giornale italiano di cardiologia
ABSTRACT
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Giornale italiano di cardiologia
ABSTRACT
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The Journal of invasive cardiology
To evaluate the radiofrequency energy and covered stents in the percutaneous reconstruction of an... more To evaluate the radiofrequency energy and covered stents in the percutaneous reconstruction of an interrupted superior vena cava in patients needing endocardial lead implantation. Patients with a history of multiple cardiac surgical procedures or with an history of infections of the pacemaker (PM) site and electrodes may develop iatrogenic occlusion of the venous access. Three patients (40, 48 and 74 years old, respectively) needing endocardial pacemaker implantation had complete obstruction of the superior vena cava. Recanalization of the superior vena cava (SVC) was undertaken under general anesthesia with orotracheal intubation. A total of 7 balloon-expandable Cheatham-Platinum 8 Zig covered stents were implanted, with a median fluoroscopy time of 58 minutes. The connection between the SVC and the right atrium was obtained, and PMs were implanted successfully in all cases. The patients' recovery was uneventful and they were discharged home 3 days later. Radiofrequency energy and the use of covered stents may be very useful in patients with complete obstruction of the SVC, particularly in subjects needing endocardial PM implantation.
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The Journal of invasive cardiology
During the past decade, transcatheter occlusion of secundum atrial septal defects (Type II ASDs) ... more During the past decade, transcatheter occlusion of secundum atrial septal defects (Type II ASDs) has become a widely accepted alternative to surgical closure. To date, over 6,000 patients have been treated with the Cardia Intrasept PFO occluder (Cardia Inc., Burnsville, Minnesota) for the percutaneous closure of patent foramen ovale (PFO). This is a report of the use of a modified Intrasept device to close Type II ASDs in 4 patients.
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Circulation
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Circulation
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Italian heart journal: official journal of the Italian Federation of Cardiology
The detection and treatment of pulmonary hypertension have become increasingly important for the ... more The detection and treatment of pulmonary hypertension have become increasingly important for the clinician. While the electrocardiogram is often used as a screening tool in patients suspected of having pulmonary hypertension, the sensitivity for detecting right ventricular hypertrophy in the era of computerized electrocardiogram analysis is highly suspect. The aim of the study was to determine the importance of clinical information in providing an accurately edited electrocardiographic system. The interpretation of the electrocardiograms of 64 consecutive symptomatic patients (12 males, 52 females, mean age 43 +/- 13 years) with isolated pulmonary hypertension provided by the computer program and the cardiologist following editing during routine daily reading sessions were reviewed. The reader (blinded cardiologist) was unaware of the clinical diagnosis. Subsequently, a cardiologist given clinical information regarding age and symptoms, edited the computer interpretation. The unblinded cardiologist diagnosed right axis deviation > 90 degrees, right ventricular hypertrophy, right ventricular strain, and right atrial enlargement in 76.6, 78.1, 71.9 and 20.3% of patients, respectively. In 6 (9.4%) patients, the electrocardiogram was normal. The blinded cardiologist and computer program diagnosed right ventricular hypertrophy in 43.8 and 39.1% respectively and most often characterized right ventricular strain as non-specific or inferior or as antero-lateral ischemia. The electrocardiogram has a high degree of sensitivity for the detection of abnormalities in symptomatic patients with isolated pulmonary hypertension. Correlation with the clinical parameters is essential to optimize the usefulness of the electrocardiogram. Consideration should be given to tailoring computerized electrocardiogram interpretative software to clinical information.
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The Canadian journal of cardiology
Primary (idiopathic or unexplained) pulmonary hypertension is a rare disease of the pulmonary vas... more Primary (idiopathic or unexplained) pulmonary hypertension is a rare disease of the pulmonary vasculature characterized by sustained elevation of pulmonary artery pressure, normal pulmonary artery wedge pressure and absence of secondary causes. Because of the nonspecific nature of early symptoms and physical findings, the diagnosis, essentially one of exclusion, is often made in the later stages of primary pulmonary hypertension. Echocardiography, providing an accurate noninvasive estimate of pulmonary pressure at rest and during exercise, is an essential component in the initial assessment and serial evaluation of patients with primary pulmonary hypertension. Furthermore, it is important to monitor the efficacy of specific therapeutic interventions, to estimate the prognosis and to detect preclinical stages of this disease.
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Archives des maladies du coeur et des vaisseaux
Prosthetic conduits, with or without biological valves, are often inserted in surgical procedures... more Prosthetic conduits, with or without biological valves, are often inserted in surgical procedures to correct or palliate cardiac malformations. The principal problem is degeneration which causes variable degrees of obstruction requiring reoperation for their replacement. The aims of this study were to assess the feasibility, safety and efficacy of a non-surgical method of treating these obstructive prostheses by dilatation-implantation of a metallic vascular endoprosthesis (stenting). Thirteen patients were treated (age range 7.7 to 36 years; mean: 15 years). Eight had pulmonary atresia with a ventricular septal defect corrected by a valved conduit from the right ventricle to the pulmonary artery which became obstructive nearly 10 years later: the implantation of the stent reduced the transconduit pressure gradient in all cases except one who had not undergone closure of the septal defect in which the cyanosis was improved. There are two cases of obstruction of a modified Blalock anastomosis in which the stent revascularised the shunt with improvement in cyanosis. In the final 3 cases, the whole Fontan procedure was compromised by obstruction of a conduit incorporated in the system, and which dilatation with stenting considerably improved. The efficacy of the procedure was constant with no complications other than rupture of the balloon in 3 cases. The good results were maintained for an average of 7.3 months (range 1 to 25 months), but it was necessary to redilate one restenosed stent after 8 months. Dilatation followed by stenting in obstructive cardiovascular prostheses is a simple, safe and effective alternative to surgical reoperation.
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Catheterization and Cardiovascular Interventions
Precise assessment of coronary artery anatomy is needed in congenital coronary malformations and ... more Precise assessment of coronary artery anatomy is needed in congenital coronary malformations and acquired coronary obstruction in children. The aim of the study was to describe our experience of selective coronary angiography (SCA) in newborns and infants. One hundred and three patients younger than 1 year of age underwent SCA. Indications were preoperative screening for coronary artery lesions or anomalous pattern (41 patients), signs of myocardial ischemia (43 patients), surgical difficulties during the reimplantation of the coronary arteries without signs of ischemia (15 patients), and other indications (4 patients). Success rate of selective injection was 100% with no significant complication. In the presence of clinical suspicion of myocardial ischemia, abnormalities of coronary artery pattern was found in 17 of 43 patients. Precious information for the surgical management was obtained in 13 of 41 patients. SCA can be performed safely even in newborns and small infants. Skills ...
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Heart (British Cardiac Society)
To evaluate the quality of life in patients with univentricular heart and to determine the impact... more To evaluate the quality of life in patients with univentricular heart and to determine the impact of sociodemographic and clinical characteristics. Retrospective, cross sectional study conducted in a regional paediatric cardiology centre. The health records of 89 survivors with univentricular heart (median age 21 years; range 17-49 years) were reviewed. Sixty seven answered the Duke questionnaire. Sociodemographic and clinical variables were similar in the responders and non-responders. The impact of sociodemographic and clinical variables on individual Duke's measures was assessed. The Duke scores of adults with univentricular heart were similar to the normal population. Cyanosis predicted a worse score for physical (p = 0.05) and perceived health measures (p = 0.02). A higher educational level predicted a better score for physical (p = 0.004), mental (p = 0.01), and general health measures (p = 0.02). Orthopaedic problems worsened the social score (p = 0.05). Psychosocial prob...
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European Heart Journal
Aim To report the experience of 23 tertiary referral European Centres on transcatheter closure of... more Aim To report the experience of 23 tertiary referral European Centres on transcatheter closure of congenital ventricular septal defects (VSD). Methods and results Implantation of transcatheter devices was attempted in 430 patients (pts) with congenital VSDs until July 2005. The following anatomic types were present: 119 muscular, 250 peri-membranous, 16 multiple, 45 residual post-surgery. Median VSD size was 7 mm (range 3–22), fluoroscopy time 33 min (range 3–146). Devices implanted were Amplatzer muscular or membranous devices in 364, PDA devices in 12, ASD devices in seven, Starflex in seven, and coils in nine patients. Procedure was suc-cessful in 410 cases (95%). Complications: device embolization in five cases (surgery in two, catheter retrieval in three), aortic regurgitation in 14 cases (two of which requiring surgery), tricuspid regurgita-tion in 27 cases (no surgery was necessary), minor rhythm disturbances in 10 pts, death in one patient, complete heart block (cAVB) in 16 ...
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Papers by Gianfranco Butera