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Neisseria elongata (NE) is an aerobic Gram-negative organism that constitutes part of the commensal human normal oropharyngeal flora. Although previously considered not to be pathogenic, it has been recognized as an occasional cause of significant infections in humans. We report here the first case in Italy of infective endocarditis of a native prolapsing mitral valve in a patient with Marfan syndrome, caused by NE subspecies nitroreducens which has been rarely isolated from clinical specimens. The culprit organism has been confirmed by mass spectrometry directly from the positive blood culture, as previously reported. The amplified gene has been deposited in GenBank under accession number KT591873. In spite of the reported aggressive nature of NE, clinical remission was promptly obtained, there being no requirement for surgery.

Background Anthracyclines can cause left ventricular (LV) dysfunction. There is little data about right ventricular (RV) damage during chemotherapy. Aim This study aimed to investigate the toxic effects of chemotherapy, analyzing its impact on right ventricular function. Material and Methods A prospective study was conducted, enrolling 83 female patients (55 ± 11 years old) affected by breast cancer treated with anthracyclines. Cardiological evaluation, HFA risk score assessment and comprehensive echocardiogram, including speckle tracking analysis and 3D analysis, were performed before starting chemotherapy (T0) and at 3 (T1), 6 (T2) and 12 months (T3) after beginning treatment. RV function was assessed with tricuspid annular plane excursion (TAPSE), S’ wave of the tricuspid annulus, fractional area change (FAC), RV global longitudinal strain (RV-GLS), free wall strain (RV-FWLS) and RV 3D ejection fraction (RV-3DEF). Subclinical LV CTRCD was defined as a reduction of GLS > 15% compared to baseline. Subclinical RV cardiotoxicity was defined as the co-presence of a relative decrease of 10% from baseline in RV-3DEF and a relative reduction of 15% from baseline RV-FWLS. Results After chemotherapy, we found a significant reduction in 2D-LVEF ( p  =  < 0.001) and 3D-LVEF ( p  =  < 0.001), in LV-GLS and RVLS ( p  =  < 0.001), in FAC and TAPSE, also RV-3DEF reduced significantly ( p  = 0.002). 39% of patients developed LV subclinical CTRCD; 28% of patients developed RV subclinical cardiotoxicity. LV and RV changes occurred concomitantly, and no RV echocardiographic parameters were found to predict the development of LV CTRCD and vice-versa. Conclusion After anthracyclines-based chemotherapy, LV and RV subclinical damage occurs, and it can be detected early by speckle-tracking and 3D echocardiography.

Closure of paravalvular leak (PVL) regurgitation after self-expandable (SE) transcatheter aortic valve implantation (TAVI) may be more challenging than after balloon-expandable (BE) valve implantation. An 85-year-old woman suffering from long-standing atrial fibrillation and severe symptomatic aortic stenosis underwent SE TAVI (26 mm Evolut™ R®, Medtronic Inc., MN, USA). A total of eighteen months after TAVI she was admitted for congestive heart failure and two-dimensional (2D) transesophageal echocardiography (TEE) color Doppler showed moderate-severe PVL regurgitation due to a long and heavily calcified leak located below the left coronary sinus. The patient was deemed to be at prohibitive surgical risk and a catheter-based PVL closure procedure was planned. A first attempt to cross the PVL from the femoral artery was unsuccessful due to an inappropriate angle between the catheter and the entry site of this hard-to-approach calcified leak. A Terumo hydrophilic guidewire 0.35 inch-260 cm from the right radial artery was then successfully advanced across the leak to the left ventricle (LV); however, of most of the catheters used, only a Glidecath 4-Fr could cross the leak over the hydrophilic wire. The hydrophilic guidewire was replaced with a stiffer guidewire that, after creating a loop in the LV, was advanced across the self-expandable valve into the descending aorta where it was snared and externalized through the left femoral artery, thus creating an arterio-arterial (AA) loop. A 6-Fr Multipurpose guiding catheter was advanced over the exchange wire and the leak was crossed with an additional 0.0014 coronary guidewire (PILOT, Abbott Vascular), predilated with two non-compliant balloon dilatation catheters, and finally, the PVL was engaged with a 3.0 mm × 12 mm Shockwave balloon (Shockwave Medical Inc, Santa Clara, California, USA). Intravascular lithotripsy (IVL) application to this highly calcified leak and the increased support provided by the stiff guidewire finally allowed the progression of the 6-Fr dedicated delivery sheath (ODS III) into the LV. A 5 mm square twist (ST) device (PLD, Occlutech, Helsingborg, Sweden) was successfully deployed within the leak and the final echocardiographic and angiographic control confirmed the effective PVL closure. In patients at high surgical risk with moderate to severe regurgitation after SE TAVI due to a hard-to-approach calcified long tract, an extra AA support loop is mandatory during percutaneous PVL closure. Furthermore, IVL application greatly facilitates the progression of the delivery sheath and occluder which is key to a successful procedure.

Aim: COVID-19 pandemic had a big impact on our life, it has revolutionized the practice of cardiology and the organization of hospital and outpatient activities. Thus the aim of our study was to assess the impact of the COVID-19 pandemic on the development of cancer therapy-related cardiac dysfunction (CTRCD). Methods and results: A single center retrospective study was carried out evaluating 96 cancer patients treated with anthracyclines and admitted to our Cardio-Oncology unit from June to August 2019 and 60 patients from June to August 2021. The incidence of CTRCD was assessed performing an echocardiogram at the time of the enrollment. We found a significantly higher incidence of CTRCD in the second period compared to first period (13% vs. 2%, p value 0.0058). In addition we found that fewer yearly visits were performed in our Cardio-oncology unit in 2021 compared to 2019 (300 patients/year in 2019 vs. 144 patients/year in the COVID era). Conclusion: COVID-19 pandemic seems to influence the onset of CTRCD in cancer patients by indirectly reducing hospital access of cancer patients and cardiological checks. In addition our data reflect the impact of the COVID-19 pandemic in the late diagnosis of cancer, in the reduction of hospital admissions and regular medical checks, in the increase of comorbidities and cardiovascular complications.

Abstract Background Transcatheter approach for large and complex atrial septal defects may represent a therapeutic challenge, particularly when the postero-inferior rim is deficient and floppy. Case summary Here, we describe a successful catheter-based closure of a large (>30 mm) secundum atrial septal defect associated with postero-inferior rim deficiency in a 35-year-old female with congestive heart failure using pulmonary vein slide-out assisted implantation technique. Discussion Inferior–posterior rim deficiency is a well-known risk factor for device instability or embolization. Transcatheter closure may represent a safe and effective alternative to the traditional surgical approach provided that modified implantation techniques are employed.

Introduction: The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. Methods: Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound–Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. Results: Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16–63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea–orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10–45 min) and the mean procedural time was 55 ± 20 min (range = 35–90 min). The total occlusion rate at follow-up (mean 50 months, range 3–100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. Conclusions: The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life.

In Italy, patients with dyslipidemia account for 15-20% of the adult population with major healthcare and socio-economic impact. According to the ESC/EAS guidelines for the management of dyslipidemias, desirable cholesterol and triglyceride levels can be achieved with a synergy between drug treatment and adequate diet therapy. However, what diets should be adopted? In this review article, different types of dietary treatments are compared, with a special focus on diet education. The new scientific frontier of nutrigenetics is also discussed.

Razionale. La coronarografia attualmente costituisce il gold standard per valutare la pervietà del bypass aortocoronarico, tuttavia questa è una metodica invasiva, che fa uso di raggi X e che ha un certo numero, seppur basso, di complicanze. Pertanto emerge l’esigenza di una metodica non invasiva dotata di buona accuratezza diagnostica per il follow-up del paziente bypassato. Scopo del nostro studio è stato confrontare la performance diagnostica della tomografia computerizzata a 40 strati rispetto all’angiografia coronarica convenzionale.Materiali e metodi. Sono stati studiati 26 pazienti di cui 20 maschi e 6 femmine con età media di 65 anni precedentemente sottoposti a rivascolarizzazione miocardica mediante bypass, con indicazione ad eseguire coronarografia non in urgenza. Sono stati esaminati un totale di 68 bypass di cui 25 arteriosi e 43 venosi, e 111 anastomosi.Risultati. È stato possibile analizzare la pervietà del bypass in tutti i pazienti; 23 pazienti presentavano una stenosi o un’occlusione del bypass con l’esecuzione dell’angiografia coronarica convenzionale; 19 di questi pazienti sono stati correttamente diagnosticati dall’angiografia coronarica eseguita mediante tomografia computerizzata (sensibilità 84%, specificità 100%). In particolare, la tomografia computerizzata ha mostrato una sensibilità del 90% e una specificità del 100% nella valutazione del corpo del bypass, mentre nei confronti dell’anastomosi ha mostrato una sensibilità dell’88% e una specificità del 94%.Conclusioni. In accordo con i risultati del nostro studio riteniamo che la tomografia computerizzata costituisca un valido ausilio diagnostico per la valutazione della pervietà del bypass in pazienti con sospetto clinico di occlusione.

Razionale. La tomografia computerizzata multidetettore (MDCT-CA) è una tecnica diagnostica non invasiva che mostra chiaramente l’anatomia delle coronarie e identifica correttamente la posizione e la morfologia delle placche ateromasiche. In questo studio abbiamo valutato l’accuratezza diagnostica della MDCT-CA nell’identificare stenosi coronariche in pazienti con patologia clinicamente significativa dell’albero coronarico.Materiali e metodi. Cinquanta pazienti (38 uomini, 12 donne, età media 60.9 ± 9.2 anni) con dolore toracico atipico, angina stabile o instabile, programmati per eseguire CVG diagnostica, sono stati sottoposti a MDCT-CA (Brilliance 40, Philips Medical Systems, Cleveland, OH, USA) entro 3 giorni prima dall’angiografia coronarica tradizionale. Criteri di inclusione: ritmo sinusale, frequenza cardiaca <70 b/min, capacità di trattenere il respiro per almeno 12 s. Criteri di esclusione: allergia nota ai mezzi di contrasto iodati, livelli di creatinina sierica >2 mg/dl, possibile gravidanza, insufficienza respiratoria, stato clinico instabile e severo scompenso cardiaco. Betabloccante è stato somministrato se la frequenza cardiaca era >70 b/min. Per sincronizzare l’arrivo del mezzo di contrasto (Iomeron 400, Bracco, Milano) nelle coronarie abbiamo utilizzato la tecnica del “bolus tracking”. L’accuratezza diagnostica è stata valutata per segmento coronarico, per vaso e per paziente.Risultati. La frequenza cardiaca media durante l’esame è stata di 61.9 ± 6.2 b/min. Abbiamo valutato 618 segmenti. La valutazione è stata inficiata da artefatti respiratori in un solo paziente (2%). La MDCT-CA ha mostrato buone specificità, sensibilità, valore predittivo positivo e negativo nell’identificazione di stenosi coronariche significative (rispettivamente 94, 94, 91 e 96% per segmento; 91, 97, 95 e 92% per vaso; 100, 100, 100 e 100% per paziente).Conclusioni. La tomografia computerizzata 40 strati ha dimostrato una buona capacità diagnostica nell’evidenziare stenosi coronariche in pazienti afferiti al nostro Istituto per patologia coronarica sospetta o già nota.

Aims The study aims at the evaluation, of patients with chest pain and uninjured coronary arteries, and the impact of diabetes mellitus on coronary microcirculation. Moreover we want to verify whether a correlation between myocardial scintigraphy results and coronary angiography or not. Methods The study population included 316 patients (173 males,143 females) with uninjured coronary arteries. Patients with chest pain (208) were divided into two populations: diabetics (72) and non-diabetics (136).We compared 66 patients with a myocardial scintigraphy with results of angiographic indexes. On angiographic images we evaluated, on the three major epicardial, Gibson’s indexes (TFC, MBG), the Yusuf’s index(TMBS) and a new index: Total Timi Frame Count (TTFC). Results Patients with positive scintigraphy had a worse TMBS than patients with negative scintigraphy (p=0.003) and a lower TFC of healthy vessels than diseased vessels (p=0.0001). We found a worse coronary microcirculation in diabetic patients with lower values of MBG and TMBS (p=0.02),compared with non- diabetics. New index TTFC is usually higher in diabetics than non-diabetic patients. Conclusion The study of microcirculation by coronary angiography and myocardial scintigraphy shows a good correlation between two methods. The analysis of diabetic patients and non-diabetic with chest pain and uninjured coronary arteries has led to assess that diabetic population has a major microcirculation disease.