Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Pediatric Cardiology (SICP), and Italian Society of Gynaecologists and Obstetrics (SIGO): pregnancy and congenital heart diseases.

The success of cardiac surgery over the past 50 years has increased numbers and median age of survivors with congenital heart disease (CHD). Adults now represent two-thirds of patients with CHD; in the USA alone the number is estimated to exceed 1 million. In this population, many affected women reach reproductive age and wish to have children. While in many CHD patients pregnancy can be accomplished successfully, some special situations with complex anatomy, iatrogenic or residual pathology are associated with an increased risk of severe maternal and fetal complications. Pre-conception counselling allows women to come to truly informed choices. Risk stratification tools can also help high-risk women to eventually renounce to pregnancy and to adopt safe contraception options. Once pregnant, women identified as intermediate or high risk should receive multidisciplinary care involving a cardiologist, an obstetrician and an anesthesiologist with specific expertise in managing this peculiar medical challenge. This document is intended to provide cardiologists working in hospitals where an Obstetrics and Gynecology Department is available with a streamlined and practical tool, useful for them to select the best management strategies to deal with a woman affected by CHD who desires to plan pregnancy or is already pregnant.

[ANMCO/GISE/SICCH Inter-Society Consensus Document: Antithrombotic therapy after surgery or structural interventional procedures for valvular heart diseases: how to treat postoperative complications]. / Documento di consenso intersocietario ANMCO/GISE/SICCH: Terapia antitrombotica nei pazienti sottoposti a chirurgia e/o interventistica cardiaca valvolare: come trattare le complicanze.

Continuous improvement of technologies, devices and drugs needs a renewal and update of current recommendations and guidelines on antithrombotic strategies, especially in those fields where literature lacks of established scientific evidences. Accordingly, the aim of this consensus statement is to provide support for antithrombotic therapy based on current guidelines and the most recent scientific evidences.After an overview on the currently available devices, the appropriate therapy according to type of procedure and implanted device is discussed. The occurrence of postoperative thromboembolic and/or hemorrhagic complications is analyzed, along with the appropriate diagnostic tools and therapeutic approach. A section is dedicated to counseling to pregnancy in women with heart valve prosthesis. Finally, the role of novel oral anticoagulants is discussed, and indications are provided for the management of patients undergoing surgery or interventional procedures on oral anticoagulation therapy.

Efficacy of closed-loop stimulation with epicardial leads in an infant with congenital atrioventricular block.

We present the case of an infant with a congenital atrioventricular block and sinus node dysfunction that was implanted with a pacemaker with physiological closed-loop stimulation (DDD-CLS) pacing mode with two epicardial leads. We have observed the response of DDD-CLS system with respect to conventional rate responsive accelerometer-based mode (DDDR): the atrial pacing percentage and the 24 h rate trend showed higher values during DDD-CLS compared with DDDR. In this patient, rate responsive feature seems preserved in DDD-CLS also using epicardial leads.

[ANMCO/SICP/SIGO Consensus document: Pregnancy and congenital heart disease]. / Documento di consenso ANMCO/SICP/SIGO: Gravidanza e cardiopatie congenite.

The success of cardiac surgery over the past 50 years has increased numbers and median age of survivors with congenital heart disease (CHD). Adults now represent two-thirds of patients with CHD; in the United States alone the number is estimated to exceed 1 million.In this population many affected women reach reproductive age and wish to have children. While in many CHD patients pregnancy can be accomplished successfully, some special situations with complex anatomy, iatrogenic or residual pathology are associated with an increased risk of severe maternal and fetal complications. Pre-conception counseling allows women to come to truly informed choices. Risk stratification tools can also help high-risk women to eventually renounce to pregnancy and to adopt safe contraception options. Once pregnant, women identified as intermediate or high-risk should receive multidisciplinary care involving a cardiologist, an obstetrician and an anesthesiologist with specific expertise in managing this peculiar medical challenge.This document is intended to provide cardiologists working in hospitals where an Obstetrics and Gynecology Department is available with a streamlined and practical tool, useful for them to select the best management strategies to deal with a woman affected by CHD who desires to plan pregnancy or is already pregnant.

Acute respiratory insufficiency and giant coronary artery aneurysm with fistula.

Several causes of acute respiratory insufficiency have been reported in the literature. We describe a case in which it was caused by a rare combination of a giant right coronary artery aneurysm with fistula that occurred in a 56-year-old woman with concomitant congenital hypothyroidism. Diagnostic tools, differential diagnosis, surgical techniques, and follow-up at 1 year are discussed.

Congenital quadricuspid aortic valve in children.

Quadricuspid aortic valves are rare congenital anomalies, usually diagnosed in adult patients affected by severe aortic regurgitation. We have now encountered three such valves in children undergoing transthoracic echocardiography. All children were asymptomatic. The first child possessed a valve with two larger leaflets, and smaller leaflets of equal size. In the second child, 3 leaflets were of equal size, with 1 small accessory leaflet. The third child had a valve with four leaflets of approximately equal size. In one child, the aortic valve was functioning normally, and came to attention because of mitral valvar prolapse causing mild regurgitation. In the remaining two children, central mild aortic regurgitation was detected using colour flow analysis, and associated dilation of the aortic root was revealed by measurements of the cross-sectional images.

Clinical and electrophysiological characteristics, and relatively benign outcome, of typical atrioventricular nodal reentrant tachycardia in children and adolescents.

BACKGROUND: Atrioventricular nodal re-entrant tachycardia is an uncommon arrhythmia in children. The natural history of this disturbance is poorly known in young patients. METHODS: We analyzed the clinical and electrophysiological features, and the final outcome, in 19 children affected by typical atrioventricular nodal re-entrant tachycardia diagnosed by a transoesophageal electrophysiological study. RESULTS: Of the cohort, 12 patients were female and 7 male, with a mean age of 11 years. Dual atrioventricular nodal physiology was demonstrated in 14 children (73%). The mean length of the tachycardia cycle was 297 milliseconds, with periods of 2 to 1 atrioventricular block during tachycardia noted in 5 children (26%). The mean cycle length was significantly shorter in the children who presented episodes of 2 to 1 atrioventricular block than in those who did not. After diagnosis, 12 children were not treated, 6 were treated with medical therapy, and 1 was submitted to radiofrequency transcatheter ablation. During a mean follow-up period of 41 months, 2 children with rare, but sustained, episodes of tachycardia that initially had not been treated were submitted to radiofrequency transcatheter ablation. Among children treated pharmacologically, 1 teenager was submitted to radiofrequency transcatheter ablation on the basis of parental choice, 3 children have discontinued medical therapy recording only sporadic episodes of tachycardia, and 2 children are still treated with antiarrhythmic drugs. At the last follow-up visit, 13 children (68%) were without any treatment, 4 had been successfully ablated, and 2 were still on medical treatment. CONCLUSIONS: Our data indicates a relatively benign outcome in this group of children and adolescents with atrioventricular nodal re-entrant tachycardia.

Permanent cardiac pacing for severe pallid breath-holding spells.

We report the case of an infant affected by frequent episodes of loss of consciousness with the clinical features of pallid breath-holding attacks. Prolonged asystole, up to 26 seconds, was demonstrated by Holter monitoring. The patient was treated with permanent pacemaker implantation, followed by complete symptom resolution during a 26-month follow-up.

Patent ductus arteriosus and left coronary ostium stenosis: an hybrid approach.

Nowadays combination of surgical procedures and interventional cardiology has been increasingly reported in literature for the treatment of coronary artery diseases. To confirm the applicability of such an approach we present a case where several approaches could be considered. A 56-year-old lady with incidental finding of patent ductus arteriosus (PDA) and concomitant left main coronary artery ostium stenosis was scheduled to have PDA transcatheter closure and surgical angioplasty of the coronary ostium. This 'hybrid' approach to such an unusual clinical presentation was successful and at 1 year follow-up the patient is symptoms free and no residual shunts have been detected.