Bahaa Fadel - Academia.edu (original) (raw)

Papers by Bahaa Fadel

Research paper thumbnail of Spectral Doppler of the Hepatic Veins in Noncardiac Diseases: What the Echocardiographer Should Know

Echocardiography, 2015

In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressu... more In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressure within the right atrium. Thus, interrogation of blood flow in the HVs is highly useful for the evaluation of right heart hemodynamics and has become an integral part of any routine echocardiographic examination. However, flow in the HVs is also affected by the state of the liver parenchyma and by the fluctuation of pressure within the thoracic cavity. Therefore, liver and pulmonary pathologies influence the flow pattern in the HVs and may lead to its dissociation from right heart hemodynamics. Echocardiographers should familiarize themselves with the findings on HV Doppler in noncardiac diseases to avoid misinterpretation and incorrect diagnosis.

Research paper thumbnail of The Various Hemodynamic Profiles of the Patent Ductus Arteriosus in Adults

Echocardiography, 2015

The patent ductus arteriosus (PDA) has diverse clinical and hemodynamic manifestations depending ... more The patent ductus arteriosus (PDA) has diverse clinical and hemodynamic manifestations depending on its size and the degree of the ensuing left-to-right shunt. A small PDA that causes minor shunting has no major hemodynamic consequences. Conversely, a large PDA with a significant left-to-right shunt may lead to various hemodynamic abnormalities. These include left-sided volume overload that may result in heart failure and/or pulmonary hypertension, the latter being a flow-dependent and mostly reversible phenomenon. The most feared complication is the development of severe and irreversible pulmonary hypertension (Eisenmenger physiology). In this manuscript, we provide examples of the various hemodynamic profiles of PDA as assessed by echocardiography in the adult population.

Research paper thumbnail of Metal through metal: pacing lead across a mechanical tricuspid valve

Journal of cardiovascular medicine (Hagerstown, Md.), Jan 27, 2013

We present the case of a patient with a mechanical tricuspid valve prosthesis who underwent place... more We present the case of a patient with a mechanical tricuspid valve prosthesis who underwent placement of a pacemaker lead across the tricuspid valve.

Research paper thumbnail of Dual thrombosis of the pulmonary arterial and venous anastomotic sites after single lung transplantation: role of transesophageal echocardiography in diagnosis and management

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 2007

We present the case of a patient who developed severe respiratory and hemodynamic compromise shor... more We present the case of a patient who developed severe respiratory and hemodynamic compromise shortly after single right lung transplantation. Transesophageal echocardiography showed a large intraluminal thrombus at the right pulmonary artery anastomosis resulting in severe obstruction to flow together with thrombosis of the right pulmonary veins extending into the left atrium. After thrombectomy and surgical revision of the vascular anastomoses, the patient made an uneventful recovery. This case illustrates the usefulness of transesophageal echocardiography in the diagnosis and treatment of patients who are hemodynamically unstable after lung transplantation.

Research paper thumbnail of Monitoring cardiac function during idebenone therapy in Friedreich's ataxia

Current pharmaceutical design, 2015

Friedreich's ataxia (FA) is associated with progressive cardiac hypertrophy resulting from a ... more Friedreich's ataxia (FA) is associated with progressive cardiac hypertrophy resulting from a genetic abnormality in the frataxin gene. Cardiac involvement is the most common cause of death (59%) in FA patients. Cardiac related death occurs at a significantly younger age than non-cardiac related death. Idebenone is a short-chain quinone analogue with a potent free-radical scavenger action. This drug has the potential to preserve and even improve mitochondrial function.Studies on Idebenone treatment showed rather conflicting results on FA cardiomyopathy. The present article reviews the clinical features of FA cardiomyopathy, imaging techniques used to diagnose, follow and monitor therapy which aimed to revert FA cardiomyopathy.

Research paper thumbnail of Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes

The Journal of thoracic and cardiovascular surgery, 2009

We aimed to identify characteristics differentiating children undergoing aortic valve replacement... more We aimed to identify characteristics differentiating children undergoing aortic valve replacement by using mechanical prostheses versus the Ross procedure and to compare survival and the need for aortic valve reoperation after each procedure. From 1983 to 2004, 346 children underwent aortic valve replacement (215 underwent the Ross procedure and 131 underwent placement of a mechanical prosthesis). Factors associated with procedure choice were used to construct a propensity score for use as a covariate in regression models to adjust for potential confounding by indication. Patients undergoing the Ross procedure were younger, more likely to have a congenital cause, and less likely to have a rheumatic or connective tissue cause. They had a lower frequency of regurgitation, required more annular enlargement, and had less concomitant cardiac surgery. Competing-risk analysis showed that 16 years after aortic valve replacement, 20% of patients had died without subsequent aortic valve repla...

Research paper thumbnail of Determinants of short- and long-term outcomes following triple valve surgery

The Journal of heart valve disease, 2010

Triple valve surgery (3VS) is required in some cardiac disorders that simultaneously involve the ... more Triple valve surgery (3VS) is required in some cardiac disorders that simultaneously involve the aortic valve (AV), mitral valve (MV), and tricuspid valve (TCV). Herein are reported details of the authors' experience with 3VS, and their attempts to identify those factors associated with a poor clinical outcome. The medical records of patients who underwent 3VS between 1985 and 2005 were reviewed. A competing-risks methodology was used to determine the time-related prevalence and associated factors for three mutually exclusive end states after 3VS, namely death, valve reoperation, and survival without subsequent valve reoperation. A total of 206 consecutive patients (124 females, 82 males; median age 34 years; range: 12-82 years) underwent 3VS. The most common underlying pathology for all valves was rheumatic, followed by repair failure and prosthesis dysfunction for AV and MV, and functional regurgitation for TCV. In total, 72 patients (35.0%) had undergone prior valve surgery. ...

Research paper thumbnail of The ultimate pulsus paradoxus: failure of aortic valve opening with inspiration

European Heart Journal - Cardiovascular Imaging, 2013

Research paper thumbnail of Spectral Doppler Interrogation of the Patent Foramen Ovale-A Window to Left Heart Hemodynamics

Echocardiography, 2014

Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of th... more Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of the instantaneous pressure gradient between left and right atrium (RA). The assessment of RA pressure using the size and collapsibility of the inferior vena cava would thus allow estimation of left atrial (LA) pressure. In this article, we illustrate the value of spectral Doppler interrogation of flow across the PFO by transthoracic echocardiography as a novel and simple tool for the assessment of LA pressure and left cardiac hemodynamics in addition to the conventional noninvasive parameters. (Echocardiography 2014;00:1-7)

Research paper thumbnail of Strain Imaging of Acute Aortic Regurgitation

Journal of Cardiovascular Echography, 2012

ABSTRACT Objectives To assess left ventricular myocardial mechanics in a patient with acute sever... more ABSTRACT Objectives To assess left ventricular myocardial mechanics in a patient with acute severe aortic regurgitation.Methods Left ventricular strain was derived from two-dimensional echocardiographic data.ResultsThere is marked decrease in longitudinal and radial strain at the left ventricular base with mild reduction at the apex. Circumferential strain and rotation were mildly reduced basally and preserved apically with normal torsion.Conclusions Our findings reflect elevated wall stress, mostly at the left ventricular base, and at the longitudinal, predominantly subendocardial fibers. The apex and the circumferential midwall fibers where wall stress is lower are less affected. To our knowledge, this is the first description of left ventricular mechanics by strain imaging in acute aortic regurgitation.RiassuntoObbiettivoValutare la meccanica cardiaca in un paziente con insufficienza aortica acuta di grado severo.MetodiLo strain bidimensionale e’ stato utilizzato per valutare la deformazione miocardica.RisultatiLo studio della deformazione miocardica ha mostrato una severa riduzione dello strain longitudinale e radiale a livello basale, mentre a livello apicale lo strain risultava solo lievemente ridotto. Lo strain circonferenziale e la rotazione miocardica erano lievemente ridotte a livello basale e pressocchè normali a livello apicale con una normale torsion.ConclusioniQuesti dati dimostrano un elevato stress parietale soprattutto a livello dei segmenti basali del ventricolo sinistro e a carico delle fibre sub endocardiche principali responsabili della deformazione longitudinale. A nostra conoscenza questa è la prima descrizione della meccanica cardiaca in un paziente con insufficienza aortica acuta utilizzando lo strain imaging.

Research paper thumbnail of Concomitant use of drug-eluting balloon-expandable and self-expandable stents: An approach to avoid surgical revascularization

International Journal of Cardiology, 2014

Research paper thumbnail of CRT PedAge SciTechnol2014

Results: There were 12(60%) responders and 8(40%) nonresponders to CRT. The 2 groups were similar... more Results: There were 12(60%) responders and 8(40%) nonresponders to CRT. The 2 groups were similar for pre-CRT EF, QRS and NYHA class. Studied indexes of interventricular, longitudinal and radial intraventricular dyssynchrony before CRT were comparable. Only the presence of septal lash (SF) before CRT was signiicantly (p=0.0363) more frequent in responders (11/12, 91.7%) than in non-responders (3/8, 37.5%), (sensitivity of 91.7%, speciicity of 62.5%, accuracy of 80.2%).

Research paper thumbnail of Spectral Doppler Interrogation of the Pulmonary Veins in Atrial Septal Defect

Echocardiography, 2015

The various components of the pulmonary venous (PV) flow are linked to physiological and patholog... more The various components of the pulmonary venous (PV) flow are linked to physiological and pathological changes that predominantly occur in the left heart. Thus, spectral Doppler interrogation of the PVs provides hemodynamic insight mainly into left-sided cardiac function. An exception to the dependence of PV flow on left heart events occurs in the setting of an atrial septal defect (ASD). The latter causes a portion of the PV blood flow, intended to cross the mitral valve, to be channeled into the more compliant right heart. This phenomenon makes the PV flow more dependent on the left-to-right interatrial shunt. The identification on the PV Doppler of a pattern that suggests uncoupling with left heart hemodynamics should raise the suspicion of an underlying ASD.

Research paper thumbnail of Meta-analysis of Trials Comparing beta-Blockers, Calcium Antagonists, and Nitrates for Stable Angina

Jama-journal of The American Medical Association, 1999

Objective To compare the relative efficacy and tolerability of treatment with ␤-blockers, calcium... more Objective To compare the relative efficacy and tolerability of treatment with ␤-blockers, calcium antagonists, and long-acting nitrates for patients who have stable angina.

Research paper thumbnail of Spectral Doppler of the Hepatic Veins in Tricuspid Valve Disease

Echocardiography, 2014

Spectral Doppler recording of the hepatic veins (HV) provides a semiquantitative assessment of tr... more Spectral Doppler recording of the hepatic veins (HV) provides a semiquantitative assessment of tricuspid regurgitation (TR) severity. It complements findings on two-dimensional echocardiography and color Doppler imaging and helps to discriminate between hemodynamically significant and nonsignificant degree of regurgitation. In this manuscript, we discuss the usefulness of the HV Doppler for the diagnosis of tricuspid valve (TV) disease and provide examples of the various spectral Doppler patterns that assist in the quantification of TR.

Research paper thumbnail of Spectral Doppler Interrogation of Mitral Regurgitation -Spot Diagnosis

Echocardiography, 2015

Mitral regurgitation (MR) is one of the most common valvular lesions that are readily identified ... more Mitral regurgitation (MR) is one of the most common valvular lesions that are readily identified by transthoracic echocardiography. Color Doppler imaging is the modality of choice for the recognition of MR, and it plays an important role in the assessment of regurgitation severity. Continuous wave (CW) Doppler is commonly used to interrogate the MR signal, and this modality can provide highly useful data regarding several physiological and pathological parameters. In this manuscript, we present a series of cases that illustrate the various hemodynamic parameters that can be derived from analysis of the CW Doppler signal of MR.

Research paper thumbnail of Is the Ross Procedure a Suitable Choice for Aortic Valve Replacement in Children With Rheumatic Aortic Valve Disease?

World Journal for Pediatric and Congenital Heart Surgery, 2012

Background: Ross procedure is the aortic valve replacement of choice in children. Nonetheless, la... more Background: Ross procedure is the aortic valve replacement of choice in children. Nonetheless, late autograft reoperation for dilatation and/or regurgitation is concerning. We examine whether Ross procedure is suitable in children with rheumatic fever. Methods: Medical records of 104 children with rheumatic fever who underwent Ross procedure were reviewed (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Competing risks methodology determined time-related prevalence and associated factors for two mutually exclusive end states: autograft reoperation and death prior to subsequent reoperation. Results: Mean age was 13.8 + 2.7, 83 (80%) were males. Hemodynamic dysfunction was primarily regurgitation (n ¼ 92, 88%) and stenosis/mixed (n ¼ 12, 12%). Competing risks analysis showed that in ten years after the Ross procedure, 1% of patients died, 32% underwent autograft reoperation, and 67% were alive and free from reoperation. Ten-year freedom from aortic regurgitation greater than or equal to moderate was 63%. Ten-year freedom from autograft reoperation was 65% for regurgitation versus 90% for stenosis/mixed disease. Risk factors for autograft reoperation were earlier surgery year (PE: 0.26 + 0.06 per year; P < .001), additional surgery (PE: 0.82 + 0.39, P ¼ .04), no annular stabilization (PE: 1.21 + 0.61, P ¼ .05). Ten-year freedom from homograft replacement was 83%. Risk factors were fresh homografts (PE: 1.36 + 0.71; P ¼ .06) and aortic homografts (PE: 1.15 + 0.59; P ¼ .05). Ten-year freedom from any cardiac reoperation was 53%. Concomitant cardiac surgery was risk factor (PE: 1.37 + 0.47; P ¼ .004). Conclusions: Ross procedure in children with rheumatic fever is associated with excellent survival but results are plagued by aortic regurgitation and frequent autograft reoperation. Risk factors include preoperative regurgitation, concomitant surgery, dilated annulus, and earlier surgery era. Better patient selection in later era has mitigated autograft reoperation risk. Continued, improved candidate selection, along with modifications in autograft implantation and root/sinotubular stabilization techniques, may further decrease late autograft failure.

Research paper thumbnail of A rare case of giant congenital left atrial appendage aneurysm in a 4-month-old child

Journal of Cardiovascular Medicine, 2013

Aneurysm of the left atrial appendage is a rare pathological condition, especially during infancy... more Aneurysm of the left atrial appendage is a rare pathological condition, especially during infancy. We describe the case of a 4-month-old child with a giant congenital aneurysm of the left atrial appendage.

Research paper thumbnail of Respiratory Hemodynamics in the Hepatic Veins-Abnormal Patterns

Echocardiography, 2014

The flow pattern in the hepatic veins (HVs) is dependent on the cardiac cycle and right heart hem... more The flow pattern in the hepatic veins (HVs) is dependent on the cardiac cycle and right heart hemodynamics and influenced by the respiratory cycle and the liver parenchyma. Most disease states that affect the right heart alter the HV Doppler in a manner independent of the respiratory cycle. Some diseases that typically involve the pericardium, right ventricular myocardium, or respiratory system confer characteristic changes to the HV flow in a manner dependent on the respiratory cycle. Analysis of the HV Doppler with assessment of the respiratory changes in flow and their timing helps to distinguish among the various disease states. In this manuscript, we discuss the effect of respiration on HV flow in patients with abnormal right heart function and illustrate the use of the respiratory changes in the HV Doppler as a tool for diagnosis.

Research paper thumbnail of Respiratory Hemodynamics in the Hepatic Veins-Normal Pattern

Echocardiography, 2014

Doppler interrogation of blood flow in the hepatic veins (HVs) is a part of any comprehensive ech... more Doppler interrogation of blood flow in the hepatic veins (HVs) is a part of any comprehensive echocardiographic examination. Data derived from the HV Doppler provide a useful tool for the assessment of right heart function. Beyond its dependence on the cardiac cycle, right heart hemodynamics, and compliance of the liver parenchyma, blood flow in the HVs is influenced by the respiratory cycle. Systematic analysis of the behavior of the HV Doppler during respiration allows one to recognize normal and abnormal flow-patterns and distinguish among various disease states that involve the right heart. In this manuscript we discuss the effect of respiration on the HV Doppler in individuals with normal right heart function.

Research paper thumbnail of Spectral Doppler of the Hepatic Veins in Noncardiac Diseases: What the Echocardiographer Should Know

Echocardiography, 2015

In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressu... more In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressure within the right atrium. Thus, interrogation of blood flow in the HVs is highly useful for the evaluation of right heart hemodynamics and has become an integral part of any routine echocardiographic examination. However, flow in the HVs is also affected by the state of the liver parenchyma and by the fluctuation of pressure within the thoracic cavity. Therefore, liver and pulmonary pathologies influence the flow pattern in the HVs and may lead to its dissociation from right heart hemodynamics. Echocardiographers should familiarize themselves with the findings on HV Doppler in noncardiac diseases to avoid misinterpretation and incorrect diagnosis.

Research paper thumbnail of The Various Hemodynamic Profiles of the Patent Ductus Arteriosus in Adults

Echocardiography, 2015

The patent ductus arteriosus (PDA) has diverse clinical and hemodynamic manifestations depending ... more The patent ductus arteriosus (PDA) has diverse clinical and hemodynamic manifestations depending on its size and the degree of the ensuing left-to-right shunt. A small PDA that causes minor shunting has no major hemodynamic consequences. Conversely, a large PDA with a significant left-to-right shunt may lead to various hemodynamic abnormalities. These include left-sided volume overload that may result in heart failure and/or pulmonary hypertension, the latter being a flow-dependent and mostly reversible phenomenon. The most feared complication is the development of severe and irreversible pulmonary hypertension (Eisenmenger physiology). In this manuscript, we provide examples of the various hemodynamic profiles of PDA as assessed by echocardiography in the adult population.

Research paper thumbnail of Metal through metal: pacing lead across a mechanical tricuspid valve

Journal of cardiovascular medicine (Hagerstown, Md.), Jan 27, 2013

We present the case of a patient with a mechanical tricuspid valve prosthesis who underwent place... more We present the case of a patient with a mechanical tricuspid valve prosthesis who underwent placement of a pacemaker lead across the tricuspid valve.

Research paper thumbnail of Dual thrombosis of the pulmonary arterial and venous anastomotic sites after single lung transplantation: role of transesophageal echocardiography in diagnosis and management

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 2007

We present the case of a patient who developed severe respiratory and hemodynamic compromise shor... more We present the case of a patient who developed severe respiratory and hemodynamic compromise shortly after single right lung transplantation. Transesophageal echocardiography showed a large intraluminal thrombus at the right pulmonary artery anastomosis resulting in severe obstruction to flow together with thrombosis of the right pulmonary veins extending into the left atrium. After thrombectomy and surgical revision of the vascular anastomoses, the patient made an uneventful recovery. This case illustrates the usefulness of transesophageal echocardiography in the diagnosis and treatment of patients who are hemodynamically unstable after lung transplantation.

Research paper thumbnail of Monitoring cardiac function during idebenone therapy in Friedreich's ataxia

Current pharmaceutical design, 2015

Friedreich's ataxia (FA) is associated with progressive cardiac hypertrophy resulting from a ... more Friedreich's ataxia (FA) is associated with progressive cardiac hypertrophy resulting from a genetic abnormality in the frataxin gene. Cardiac involvement is the most common cause of death (59%) in FA patients. Cardiac related death occurs at a significantly younger age than non-cardiac related death. Idebenone is a short-chain quinone analogue with a potent free-radical scavenger action. This drug has the potential to preserve and even improve mitochondrial function.Studies on Idebenone treatment showed rather conflicting results on FA cardiomyopathy. The present article reviews the clinical features of FA cardiomyopathy, imaging techniques used to diagnose, follow and monitor therapy which aimed to revert FA cardiomyopathy.

Research paper thumbnail of Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes

The Journal of thoracic and cardiovascular surgery, 2009

We aimed to identify characteristics differentiating children undergoing aortic valve replacement... more We aimed to identify characteristics differentiating children undergoing aortic valve replacement by using mechanical prostheses versus the Ross procedure and to compare survival and the need for aortic valve reoperation after each procedure. From 1983 to 2004, 346 children underwent aortic valve replacement (215 underwent the Ross procedure and 131 underwent placement of a mechanical prosthesis). Factors associated with procedure choice were used to construct a propensity score for use as a covariate in regression models to adjust for potential confounding by indication. Patients undergoing the Ross procedure were younger, more likely to have a congenital cause, and less likely to have a rheumatic or connective tissue cause. They had a lower frequency of regurgitation, required more annular enlargement, and had less concomitant cardiac surgery. Competing-risk analysis showed that 16 years after aortic valve replacement, 20% of patients had died without subsequent aortic valve repla...

Research paper thumbnail of Determinants of short- and long-term outcomes following triple valve surgery

The Journal of heart valve disease, 2010

Triple valve surgery (3VS) is required in some cardiac disorders that simultaneously involve the ... more Triple valve surgery (3VS) is required in some cardiac disorders that simultaneously involve the aortic valve (AV), mitral valve (MV), and tricuspid valve (TCV). Herein are reported details of the authors' experience with 3VS, and their attempts to identify those factors associated with a poor clinical outcome. The medical records of patients who underwent 3VS between 1985 and 2005 were reviewed. A competing-risks methodology was used to determine the time-related prevalence and associated factors for three mutually exclusive end states after 3VS, namely death, valve reoperation, and survival without subsequent valve reoperation. A total of 206 consecutive patients (124 females, 82 males; median age 34 years; range: 12-82 years) underwent 3VS. The most common underlying pathology for all valves was rheumatic, followed by repair failure and prosthesis dysfunction for AV and MV, and functional regurgitation for TCV. In total, 72 patients (35.0%) had undergone prior valve surgery. ...

Research paper thumbnail of The ultimate pulsus paradoxus: failure of aortic valve opening with inspiration

European Heart Journal - Cardiovascular Imaging, 2013

Research paper thumbnail of Spectral Doppler Interrogation of the Patent Foramen Ovale-A Window to Left Heart Hemodynamics

Echocardiography, 2014

Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of th... more Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of the instantaneous pressure gradient between left and right atrium (RA). The assessment of RA pressure using the size and collapsibility of the inferior vena cava would thus allow estimation of left atrial (LA) pressure. In this article, we illustrate the value of spectral Doppler interrogation of flow across the PFO by transthoracic echocardiography as a novel and simple tool for the assessment of LA pressure and left cardiac hemodynamics in addition to the conventional noninvasive parameters. (Echocardiography 2014;00:1-7)

Research paper thumbnail of Strain Imaging of Acute Aortic Regurgitation

Journal of Cardiovascular Echography, 2012

ABSTRACT Objectives To assess left ventricular myocardial mechanics in a patient with acute sever... more ABSTRACT Objectives To assess left ventricular myocardial mechanics in a patient with acute severe aortic regurgitation.Methods Left ventricular strain was derived from two-dimensional echocardiographic data.ResultsThere is marked decrease in longitudinal and radial strain at the left ventricular base with mild reduction at the apex. Circumferential strain and rotation were mildly reduced basally and preserved apically with normal torsion.Conclusions Our findings reflect elevated wall stress, mostly at the left ventricular base, and at the longitudinal, predominantly subendocardial fibers. The apex and the circumferential midwall fibers where wall stress is lower are less affected. To our knowledge, this is the first description of left ventricular mechanics by strain imaging in acute aortic regurgitation.RiassuntoObbiettivoValutare la meccanica cardiaca in un paziente con insufficienza aortica acuta di grado severo.MetodiLo strain bidimensionale e’ stato utilizzato per valutare la deformazione miocardica.RisultatiLo studio della deformazione miocardica ha mostrato una severa riduzione dello strain longitudinale e radiale a livello basale, mentre a livello apicale lo strain risultava solo lievemente ridotto. Lo strain circonferenziale e la rotazione miocardica erano lievemente ridotte a livello basale e pressocchè normali a livello apicale con una normale torsion.ConclusioniQuesti dati dimostrano un elevato stress parietale soprattutto a livello dei segmenti basali del ventricolo sinistro e a carico delle fibre sub endocardiche principali responsabili della deformazione longitudinale. A nostra conoscenza questa è la prima descrizione della meccanica cardiaca in un paziente con insufficienza aortica acuta utilizzando lo strain imaging.

Research paper thumbnail of Concomitant use of drug-eluting balloon-expandable and self-expandable stents: An approach to avoid surgical revascularization

International Journal of Cardiology, 2014

Research paper thumbnail of CRT PedAge SciTechnol2014

Results: There were 12(60%) responders and 8(40%) nonresponders to CRT. The 2 groups were similar... more Results: There were 12(60%) responders and 8(40%) nonresponders to CRT. The 2 groups were similar for pre-CRT EF, QRS and NYHA class. Studied indexes of interventricular, longitudinal and radial intraventricular dyssynchrony before CRT were comparable. Only the presence of septal lash (SF) before CRT was signiicantly (p=0.0363) more frequent in responders (11/12, 91.7%) than in non-responders (3/8, 37.5%), (sensitivity of 91.7%, speciicity of 62.5%, accuracy of 80.2%).

Research paper thumbnail of Spectral Doppler Interrogation of the Pulmonary Veins in Atrial Septal Defect

Echocardiography, 2015

The various components of the pulmonary venous (PV) flow are linked to physiological and patholog... more The various components of the pulmonary venous (PV) flow are linked to physiological and pathological changes that predominantly occur in the left heart. Thus, spectral Doppler interrogation of the PVs provides hemodynamic insight mainly into left-sided cardiac function. An exception to the dependence of PV flow on left heart events occurs in the setting of an atrial septal defect (ASD). The latter causes a portion of the PV blood flow, intended to cross the mitral valve, to be channeled into the more compliant right heart. This phenomenon makes the PV flow more dependent on the left-to-right interatrial shunt. The identification on the PV Doppler of a pattern that suggests uncoupling with left heart hemodynamics should raise the suspicion of an underlying ASD.

Research paper thumbnail of Meta-analysis of Trials Comparing beta-Blockers, Calcium Antagonists, and Nitrates for Stable Angina

Jama-journal of The American Medical Association, 1999

Objective To compare the relative efficacy and tolerability of treatment with ␤-blockers, calcium... more Objective To compare the relative efficacy and tolerability of treatment with ␤-blockers, calcium antagonists, and long-acting nitrates for patients who have stable angina.

Research paper thumbnail of Spectral Doppler of the Hepatic Veins in Tricuspid Valve Disease

Echocardiography, 2014

Spectral Doppler recording of the hepatic veins (HV) provides a semiquantitative assessment of tr... more Spectral Doppler recording of the hepatic veins (HV) provides a semiquantitative assessment of tricuspid regurgitation (TR) severity. It complements findings on two-dimensional echocardiography and color Doppler imaging and helps to discriminate between hemodynamically significant and nonsignificant degree of regurgitation. In this manuscript, we discuss the usefulness of the HV Doppler for the diagnosis of tricuspid valve (TV) disease and provide examples of the various spectral Doppler patterns that assist in the quantification of TR.

Research paper thumbnail of Spectral Doppler Interrogation of Mitral Regurgitation -Spot Diagnosis

Echocardiography, 2015

Mitral regurgitation (MR) is one of the most common valvular lesions that are readily identified ... more Mitral regurgitation (MR) is one of the most common valvular lesions that are readily identified by transthoracic echocardiography. Color Doppler imaging is the modality of choice for the recognition of MR, and it plays an important role in the assessment of regurgitation severity. Continuous wave (CW) Doppler is commonly used to interrogate the MR signal, and this modality can provide highly useful data regarding several physiological and pathological parameters. In this manuscript, we present a series of cases that illustrate the various hemodynamic parameters that can be derived from analysis of the CW Doppler signal of MR.

Research paper thumbnail of Is the Ross Procedure a Suitable Choice for Aortic Valve Replacement in Children With Rheumatic Aortic Valve Disease?

World Journal for Pediatric and Congenital Heart Surgery, 2012

Background: Ross procedure is the aortic valve replacement of choice in children. Nonetheless, la... more Background: Ross procedure is the aortic valve replacement of choice in children. Nonetheless, late autograft reoperation for dilatation and/or regurgitation is concerning. We examine whether Ross procedure is suitable in children with rheumatic fever. Methods: Medical records of 104 children with rheumatic fever who underwent Ross procedure were reviewed (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Competing risks methodology determined time-related prevalence and associated factors for two mutually exclusive end states: autograft reoperation and death prior to subsequent reoperation. Results: Mean age was 13.8 + 2.7, 83 (80%) were males. Hemodynamic dysfunction was primarily regurgitation (n ¼ 92, 88%) and stenosis/mixed (n ¼ 12, 12%). Competing risks analysis showed that in ten years after the Ross procedure, 1% of patients died, 32% underwent autograft reoperation, and 67% were alive and free from reoperation. Ten-year freedom from aortic regurgitation greater than or equal to moderate was 63%. Ten-year freedom from autograft reoperation was 65% for regurgitation versus 90% for stenosis/mixed disease. Risk factors for autograft reoperation were earlier surgery year (PE: 0.26 + 0.06 per year; P < .001), additional surgery (PE: 0.82 + 0.39, P ¼ .04), no annular stabilization (PE: 1.21 + 0.61, P ¼ .05). Ten-year freedom from homograft replacement was 83%. Risk factors were fresh homografts (PE: 1.36 + 0.71; P ¼ .06) and aortic homografts (PE: 1.15 + 0.59; P ¼ .05). Ten-year freedom from any cardiac reoperation was 53%. Concomitant cardiac surgery was risk factor (PE: 1.37 + 0.47; P ¼ .004). Conclusions: Ross procedure in children with rheumatic fever is associated with excellent survival but results are plagued by aortic regurgitation and frequent autograft reoperation. Risk factors include preoperative regurgitation, concomitant surgery, dilated annulus, and earlier surgery era. Better patient selection in later era has mitigated autograft reoperation risk. Continued, improved candidate selection, along with modifications in autograft implantation and root/sinotubular stabilization techniques, may further decrease late autograft failure.

Research paper thumbnail of A rare case of giant congenital left atrial appendage aneurysm in a 4-month-old child

Journal of Cardiovascular Medicine, 2013

Aneurysm of the left atrial appendage is a rare pathological condition, especially during infancy... more Aneurysm of the left atrial appendage is a rare pathological condition, especially during infancy. We describe the case of a 4-month-old child with a giant congenital aneurysm of the left atrial appendage.

Research paper thumbnail of Respiratory Hemodynamics in the Hepatic Veins-Abnormal Patterns

Echocardiography, 2014

The flow pattern in the hepatic veins (HVs) is dependent on the cardiac cycle and right heart hem... more The flow pattern in the hepatic veins (HVs) is dependent on the cardiac cycle and right heart hemodynamics and influenced by the respiratory cycle and the liver parenchyma. Most disease states that affect the right heart alter the HV Doppler in a manner independent of the respiratory cycle. Some diseases that typically involve the pericardium, right ventricular myocardium, or respiratory system confer characteristic changes to the HV flow in a manner dependent on the respiratory cycle. Analysis of the HV Doppler with assessment of the respiratory changes in flow and their timing helps to distinguish among the various disease states. In this manuscript, we discuss the effect of respiration on HV flow in patients with abnormal right heart function and illustrate the use of the respiratory changes in the HV Doppler as a tool for diagnosis.

Research paper thumbnail of Respiratory Hemodynamics in the Hepatic Veins-Normal Pattern

Echocardiography, 2014

Doppler interrogation of blood flow in the hepatic veins (HVs) is a part of any comprehensive ech... more Doppler interrogation of blood flow in the hepatic veins (HVs) is a part of any comprehensive echocardiographic examination. Data derived from the HV Doppler provide a useful tool for the assessment of right heart function. Beyond its dependence on the cardiac cycle, right heart hemodynamics, and compliance of the liver parenchyma, blood flow in the HVs is influenced by the respiratory cycle. Systematic analysis of the behavior of the HV Doppler during respiration allows one to recognize normal and abnormal flow-patterns and distinguish among various disease states that involve the right heart. In this manuscript we discuss the effect of respiration on the HV Doppler in individuals with normal right heart function.