Perclose Proglide™ for vascular closure.

In the past 20 years, numerous percutaneous vascular closure devices have been tested and compared with manual compression and to surgical cut-down. The suture-mediated closure device Perclose ProGlide™ system (Abbott Vascular, CA, USA) emerged as a safe and effective alternative for many procedures requiring either small or large bore vascular accesses. In this review, we will discuss the characteristics of this vascular closure device and the main studies that proved its potential to reduce vascular complications, time to deambulation, time to discharge and patient discomfort.

Three-year results of repaired Barlow mitral valves via right minithoracotomy versus median sternotomy in a randomized trial.

OBJECTIVES: To clarify whether the results of repair of a complex mitral lesion (Barlow valve) at the intermediate-term follow-up are independent of the mode of surgical access [minithoracotomy vs. median sternotomy (MS)]. METHODS: In a prospective randomized study of mitral repair for Barlow disease using either a minimally invasive (MI) approach or MS, we achieved an average follow-up of 3 years (echocardiography, physical examination and quality of life). Mitral repair was achieved with polytetrafluoroethylene chordal implantation for both leaflets. RESULTS: Both groups included 80 patients. Mechanical ventilation time and intensive care unit and hospital stay were shorter in the MI group (p = 0.01, p = 0.013 and p = 0.02, respectively). During the follow-up, 5 patients in each group (6.25%) displayed mild mitral regurgitation, while 2 patients in each group (2.5%) developed recurrent regurgitation graded as at least moderate/severe. The rate of mitral reoperation was 2.5% in the MI group and 1.25% in the MS group (p = 0.9). The overall follow-up mortality was 3.75% in both the MI and the MS groups. CONCLUSIONS: The 3-year results of repair of Barlow valves were satisfactory irrespective of the approach used to repair the valve. The advantages of MI surgery can be achieved in patients with mitral Barlow disease without concerns over the durability of repair.

Immediate and midterm follow-up results of excimer laser application in complex percutaneous coronary interventions: Report from a single center experience.

OBJECTIVE: To assess the efficacy and safety of laser-assisted percutaneous coronary interventions (PCI) in an unselected population. METHODS: One hundred consecutive patients, who underwent a laser assisted PCI between January 2008 and March 2012, were included in the present study. Fifty-one patients underwent laser ablation for thrombus vaporization (Group 1), 36 patients for neointima/plaque debulking (Group 2) and 13 patients for lesion compliance modification in calcified lesions (Group 3). RESULTS: The rate of in-hospital serious events was 2%. The cumulative laser success was 82%, and it was significantly higher for Group 1 and Group 2 in comparison with Group 3 (p = 0.001). Furthermore, the need for repeat revascularization was significantly higher in the Group 3 compared with the others two groups (46% vs. 8% for Group 1 and 11% for Group 2, p = 0.03). The MACE rate was 14%. There was a trend toward a higher MACE rate in the Group 3 compared with others two groups (p = 0.05). CONCLUSIONS: Laser ablation is an effective and safe tool for complex PCI. Patients underwent laser for thrombus vaporization or for neointima/plaque debulking had better immediate success and better outcome at follow-up than patients underwent laser for lesion compliance modification.

Are age and gender associated to tobacco use and knowledge among general practitioners? Results of a survey in Italy.

OBJECTIVES: The aim of this study was to assess knowledge and opinions of Italian general practitioners about the effectiveness of smoking cessation interventions and physicians' attitudes in addressing tobacco-related issues. METHODS: The survey was carried out through a questionnaire administered to general practitioners (GPs) attending a medical refresher course. 133 Italian GPs participated in the study with a mean age of 51.4 years (SD = 6.2). RESULTS: The GPs had good knowledge about the predictors of smoking onset, pharmacotherapies for tobacco cessation and the clinical guidelines recommendations. Wrong answers were encountered for the prevalence of smokers in Italy, the Fagerström Test for nicotine dependence and minimal advice. Females were more subjected to higher knowledge about tobacco, and at lower risk to be a smoker/ex smoker. Furthermore, physicians ≥ 50 years old living in northern Italy had higher knowledge score. CONCLUSIONS: Physician education on tobacco counseling is associated to increased comfort and practice in advising patients who smoke. Tobacco cessation training might increase the success rate of helping patients to quit smoking.

Mediterranean diet and familial dysmetabolism as factors influencing the development of acne.

AIM: To investigate the effects of adherence to the Mediterranean diet and familial dysmetabolisms on acne development. METHODS: A community-based case-control study was carried out in Italy enrolling cases as acneic outpatients of a dermatological ambulatory service and controls as clinically healthy acne-free subjects. Food consumption were evaluated with a validated food-frequency questionnaire, exploring the consumption of pasta, meat, cheese, fish, fruit, vegetables, and olive oil. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean diet scale that incorporated the main characteristics of this diet. A logistic regression analysis estimated the variables who predicted the odds of being case, using those variables that at the univariate analysis yielded a p-value <0.25. Results are presented as odds ratio (OR) or adjusted OR (AOR). RESULTS: The study included 93 cases (36.6% males, median age 17 years) and 200 controls (32% males, median age 16 years). The Mediterranean diet score ≥6 revealed a protective effect towards acne (crude OR 0.22, 95% CI 0.08-0.64). Logistic regression analysis showed that familial hypercholesterolaemia, diabetes, and hypertension are strong risk factors for acne (AOR 8.79, 95% CI 1.67-46.22; 3.32, 95% CI 1.27-8.63; and 2.73, 95% CI 1.07-6.96, respectively), while the Mediterranean diet represents a protective factor (score ≥6, AOR 0.31, 95% CI 0.11-0.89). CONCLUSIONS: The odds for familial dysmetabolisms was higher in cases than in controls, confirming their role in determining or maintaining acne. Moreover, this is the first study demonstrating a protective role of the Mediterranean diet in the pathogenesis of acne.

Large coronary aneurysm following laser angioplasty of the left anterior descending coronary artery.

Coronary aneurysm is a rare complication after coronary excimer laser angioplasty. A 45-year-old woman underwent laser angioplasty and bare metal direct stenting of the proximal segment of the left anterior descending artery (LAD); after 3 months, angiographic follow-up showed significant ostial stenosis of the LAD with a large sacciform aneurysm and diffuse intrastent restenosis.

[Adolescents' affectivity and sexuality: a randomized trial of the efficacy of a school health promotion intervention in a primary school]. / Affettività e sessualità tra gli adolescenti: trial randomizzato sull'efficacia di un intervento di promozione della salute nella scuola secondaria di primo grado.

A cluster randomised trial was conducted to evaluate the efficacy of a health promotion intervention aimed at improving knowledge and preventing sexually transmitted diseases (STD) amongst Grade 9 primary school students in Salerno (Italy). Students were randomized to either one of two groups: intervention group or control group. The intervention group was required to attend three meetings, each lasting one and a half hours. A questionnaire was then administered to both groups to evaluate knowledge of STD, contraception, sexuality, affectivity, satisfaction with interpersonal relationships with family, social groups and healthcare professionals. Variations of knowledge in the two groups were evaluated through calculation of odds ratios. Three hundred twenty-two students participated in the study. All students who received the study intervention were able to identify at least one STD post-intervention, while 2.5% of students in the control group did not indicate any. Students in the intervention group were more likely to select condoms as the most suitable contraception for young people (OR 5.54; 95% CI 3.27 -9.38), compared to controls (OR 1.91; 95% CI 1.20 - 3.05) (p = 0.002). They were also better aware of the possibility of contracting a STD even after incomplete sexual intercourse (OR 0.21, 95% CI 0.13 to 0.35), with a statistically significant difference (p <0.001) compared to the control group (OR 0.71, 95% CI 0.45 to 1.11). In addition, students in the intervention group were more likely to turn to their own parents when having doubts about sexual issues (p = 0.004) and female students to consider their gynecologist as a reference figure. In conclusion, the findings indicate that students randomized to the intervention group were more informed and aware of issues related to sexuality and its associated risks.

Long-term results of ablation for isolated atrial fibrillation through a right minithoracotomy: toward a rational revision of treatment protocols.

OBJECTIVE: Despite continued technical improvements, results of transcatheter radiofrequency ablation of atrial fibrillation may be suboptimal in some patient subgroups. Short-term follow-up of minimally invasive epicardial ablation of isolated atrial fibrillation has been encouraging. METHODS: One hundred four patients with drug-refractory isolated atrial fibrillation underwent minimally invasive surgical ablation through right 3- to 4-cm minithoracotomy by isolation of pulmonary veins and were followed-up for an average of 17 months. Previous failed transcatheter ablation was not a criterion for this procedure. Antiarrhythmic drugs were continued until postoperative month 6, despite demonstration of stable sinus rhythm. RESULTS: The procedure was confirmed to be safe (1 case of procedure-related morbidity, no operative deaths) and effective (89% overall freedom from recurrent arrhythmia at follow-up, 96% freedom from paroxysmal atrial fibrillation, 80% freedom from persisting type atrial fibrillation). Results tended to improve with the expansion of the surgical experience. Cox hazard regression and Kaplan-Meier analysis identified persisting type atrial fibrillation and enlarged left atrium as the major predictors of recurrent atrial fibrillation at follow-up. Health-related quality of life was confirmed to be improved at the end of the follow-up relative to baseline in most Medical Outcomes Study 36-Item Short-Form Health Survey domains. CONCLUSIONS: Minimally invasive epicardial ablation of isolated atrial fibrillation yields stable, gradually improving results. Earlier surgical referral is justifiable after careful cardiologic work-up. To define the relative roles of minimally invasive ablation and transcatheter ablation, which may be considered in the future as alternative therapies, a randomized trial to compare these procedures is advisable.

One-year results after implantation of the CorCap for dilated cardiomyopathy and heart failure.

BACKGROUND: We conducted a prospective study of the clinical outcomes and health-related quality of life after implantation of the CorCap support device (Acorn Cardiovascular Inc, St Paul, MN) for dilated cardiomyopathy. METHODS: The criteria adopted for CorCap implantation were dilated cardiomyopathy (left ventricular [LV] end-diastolic diameter≥60 mm, LV ejection fraction≤0.30 and >0.10), and New York Heart Association functional class II or III despite maximal medical therapy. Echocardiographic follow-up and evaluation with the Short Form-36 questionnaire were performed. RESULTS: Included were 39 patients: 5 in New York Heart Association class II and 32 in class III. At 13.3±2.5 months of follow-up, a statistically significant improvement was evident in mean LV volume (LV end-systolic volume from 202±94 to 138±72 ml. p=0.005) and systolic function (LV ejection fraction from 0.26±0.05 to 0.36±0.05, p<0.001). The mean LV sphericity index was significantly increased at the end of the follow-up (p=0.009). Ischemic etiology, diabetes, advanced age, and LV ejection fraction of less than 0.15 predicted lesser reversal of the LV alterations. Operative mortality was 5.1%. Cumulative follow-up mortality was 10.2%. The average Physical Health domain scores (Physical Functioning, Role Physical, General Health) were improved. Average Mental Health domain scores were also increased. CONCLUSIONS: The cardiac support device obtains reverse remodelling of the LV and is useful to improve the quality of life of patients with dilated cardiomyopathy and New York Heart Association class III symptoms of heart failure. The integration of different and complementary strategies (cardiac support device and resynchronization therapy) may represent the key to success for more complex patients, although further studies are required.

Manual versus nonmanual thrombectomy in primary and rescue percutaneous coronary angioplasty.

Although many thrombectomy devices have been tested in ST-segment elevation acute myocardial infarction (STEMI), there are no comparative data on safety or effectiveness in thrombectomy or ST-segment resolution. This study compares manual versus nonmanual thrombectomy devices in patients undergoing primary or rescue percutaneous coronary intervention in a tertiary care center. We identified 232 consecutive patients with STEMI and time from symptom onset to emergency room contact of < or = 12 h undergoing percutaneous coronary intervention with coronary thrombectomy devices. Primary end point was ST-segment resolution of > or = 70%. Several angiographic, procedural and clinical secondary end points were also evaluated. The manual thrombectomy group included 110 patients and the nonmanual group 122 patients. Both groups were similar in their clinical characteristics. The primary end point occurred with similar frequency in patients treated with manual versus nonmanual thrombectomy (67.9% vs 60.0%, P = 0.216). No significant differences were found in the two groups with regard to procedural complications, angiographic reperfusion parameters, in-hospital major adverse cardiac events, or infarct size, whereas manual thrombectomy was associated with a better left ventricle ejection fraction at discharge. Furthermore, treatment with a manual thrombectomy device was associated with significantly shorter procedural times (69 min vs 95 min, P < 0.001) and lower procedural costs (2981 euros vs 7505 euros, P < 0.001). The use of manual thrombus-aspiration catheters appeared equivalent to nonmanual thrombectomy devices in the setting of primary or rescue percutaneous intervention in terms of clinical efficacy, and led to shorter procedures and cost savings.

[Manual thrombus aspiration with the Export catheter during primary and rescue angioplasty. Predictors of failed myocardial reperfusion]. / Trombo-aspirazione manuale con catetere Export nell'angioplastica primaria e di salvataggio. Predittori di mancata riperfusione miocardica.

BACKGROUND: Manual thrombus aspiration seems to improve myocardial reperfusion after coronary angioplasty in patients with ST-elevation acute coronary syndrome. We sought to assess the independent variables of complete myocardial reperfusion after primary and rescue coronary angioplasty with use of the Export manual thrombus aspiration catheter. METHODS: Myocardial reperfusion were judged complete if ST-segment resolution were >70% at 60 min post-procedure ECG. Sixty-three consecutive patients undergoing primary (81%) or rescue angioplasty (19%) with use of the Export catheter were analyzed. RESULTS: Forty-three (68%) patients had a complete myocardial reperfusion and 20 (32%) patients did not. The independent predictors of failed myocardial reperfusion, at multivariate analysis, were: heart rate at hospital admission (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01-1.09; p = 0.007), time to angioplasty >3 h (OR 6.07; 95% CI 1.31-27.97; p = 0.005), left anterior descending coronary artery involvement (OR 8.8; 95% CI 2.12-36.4; p = 0.003). CONCLUSIONS: The present study shows that in the setting of primary or rescue angioplasty with use of Export manual thrombus aspiration catheter, patients with high heart rate on admission, an ischemic time >3 h and left anterior descending coronary artery involvement are at higher risk of failed myocardial reperfusion.

[A rare case of a post-traumatic intraventricular defect]. / Un raro caso di difetto interventricolare post-traumatico.

Cardiac injury occurs in about 20-30% of major chest traumas; 80% of penetrating cardiac wounds are fatal; the survival rate is related to the mechanism of injury (whether by stab wound or gunshot wound), the extent of injury, the need for emergency room thoracotomy for resuscitation, and the presence of cardiac tamponade. The right ventricle and atrium are the most commonly involved cardiac chambers. We present a case of 63-year-old male patient who presented with a systolic murmur after a chest wall stab wound. Transthoracic echocardiogram revealed a small pericardial effusion and laceration of the interventricular septum. Cardiac catheterization revealed a moderate increase in mean pulmonary artery pressure and a moderate left to right shunt, due to interventricular defect which was closed percutaneously. The presented case is very unusual: the clinical picture was very poor because of the spontaneous closure of the wound, the absence of signs of cardiac tamponade, and the moderate size of the defect. We emphasize the role of echocardiography in the anatomic and functional evaluation of such lesions.

[Rheolytic percutaneous thrombectomy with Angiojet (Possis) catheter in acute coronary syndromes. Report of 3 cases and technical considerations]. / La trombectomia percutanea di tipo reolitico con catetere Angiojet (Possis) nelle sindromi coronariche acute. Presentazione di tre casi e considerazioni tecniche.

Mechanical thrombolysis in acute coronary syndromes is poorly understood and is still considerably underused in interventional cardiology. The authors report 3 cases of thrombotic coronary obstruction successfully treated with the Possis Angiojet system. In the first case, coronary angiography which demonstrated a large subocclusive thrombus in the mid right coronary artery was performed in a patient with unstable angina following acute myocardial infarction. Removal of the bulk of the thrombus through the activation of the Angiojet system allowed safe and direct stenting of the residual obstruction. In the second case, the Angiojet system was used to remove a thrombus which prolapsed within a stent during a primary angioplasty procedure on the left anterior descending coronary artery. The third case demonstrates the efficacy of the Possis Angiojet system in cleaning up an extensively thrombosed vein graft of an elderly patient with acute anterior myocardial infarction and cardiogenic shock. After thrombus debulking and restoration of TIMI 3 flow in the graft and in the native left anterior descending coronary artery, the left ventricular function was restored and the hemodynamic picture improved. This technique, the indications and results of this promising new device are discussed and reviewed in detail.