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Francesco Arrigo

Publications and source records attributed to Francesco Arrigo.

13 recordsLinked to original sources
PubMed2006

Imaging of left main coronary artery dissection with multislice computed tomography.

We occurred in a left main (LM) dissection during primary coronary intervention in a 45-year-old man with anterior acute myocardial infarction. Successful, multiple direct stenting was performed from the ostial to the mid left anterior descending coronary artery (LAD). Nonetheless, an LM dissection involving the proximal circumflex artery (Cx) was still evident at the end of the intervention. Multislice Computed Tomography (MSCT) coronary angiography images showed that LM dissection was definitely long and close to the ostium; moreover, the proximal stent had both excluded the false lumen in the LAD and stabilized the dissection towards the Cx. Two months later, at MSCT coronary angiography the LM dissection was still evident and the patient had remained totally asymptomatic. MSCT coronary angiography can be recommended as a complementary diagnostic tool for the assessment of LM anatomy because of the possibility of three-dimensional reconstructions and consequent clear evaluation of its take-off, course and bifurcation.

Aortic Dissection↗
PubMed2006

Cardiac imaging in the evaluation of mitral annulus caseous calcification.

The current case report illustrates a comprehensive assessment with different imaging techniques, as echocardiography, magnetic resonance and computer tomography, of a rare cardiac mass known as caseous calcification of mitral annulus. Transesophageal echocardiography was able to identify and characterize the caseous calcification of mitral annulus.

Aged, 80 and over↗
PubMed2005

Behavior of both epicardial and intramural coronary artery flow velocities in various models of myocardial hypertrophy: role for left ventricular outflow tract obstruction.

BACKGROUND: The assessment of coronary flow velocity is becoming crucial in the diagnosis and management of several cardiac dysfunctions and conventional Doppler echocardiography is currently the technique most widely used for detecting their abnormalities noninvasively. METHODS: We sought to evaluate the differences in coronary flow velocity using conventional transthoracic Doppler echocardiography, measuring both the left anterior descending and such intramural (IM) coronary arteries' flow, among the following 4 categories of patients with myocardial hypertrophy: group A, obstructive hypertrophic cardiomyopathy (n = 12); group B, nonobstructive hypertrophic cardiomyopathy (n = 10); group C, left ventricular hypertrophy (LVH) due to hypertension (n = 10); and group D, LVH due to aortic valve stenosis (n = 10). RESULTS: No significant difference between the 4 groups was found with respect to the left anterior descending velocity. Diastolic peak (P < .01) and mean (P < .05) velocities in the IM arterioles were significantly higher in patients from groups A and D than in groups B and C. At multivariate analysis, both dynamic (group A) and fixed (group D) systolic peak gradients, measured by continuous wave Doppler sampling through the left ventricular (LV) outflow tract or the aortic valve, respectively, were found to be major determinants of the IM diastolic velocity, independently on the LV mass. About 75% of patients with obstructive hypertrophic cardiomyopathy showed IM peak and mean velocity >100 cm/s and >70 cm/s, respectively (P = .005). CONCLUSION: These findings likely suggest [corrected] a role for the LV systolic obstruction within the intricate adaptive mechanisms of coronary blood flow to LVH.

Aged↗
PubMed2005

Serum levels of osteoprotegerin and RANKL in patients with ST elevation acute myocardial infarction.

OPG (osteoprotegerin) has been suggested to have an important role in atherogenesis and vascular calcification. In the present study, we have investigated serum OPG and RANKL (receptor activator of nuclear factor kappaB ligand) concentrations in patients with ST elevation AMI (acute myocardial infarction) and established CAD (coronary artery disease). OPG and RANKL were measured in 58 male patients hospitalized in the coronary care unit with ST elevation AMI, in 52 asymptomatic male patients with an established diagnosis of CAD and in 52 healthy male controls. These last two groups were matched with the AMI patients for age and body mass index. OPG was significantly (P<0.05) higher in patients with AMI at 1 h after AMI (8.04+/-4.86 pmol/l) than in both patients with established CAD (4.92+/-1.65 pmol/l) and healthy subjects (3.15+/-1.01 pmol/l). Subjects with established CAD had significantly (P<0.05) increased OPG levels compared with controls. RANKL levels in patients with established CAD (0.02+/-0.05 pmol/l) and with AMI (0.11+/-0.4 pmol/l) were significantly (P<0.05) lower compared with controls (0.32+/-0.35 pmol/l). In the AMI group, OPG decreased significantly (P<0.05) at 1 and 4 weeks after infarction (8.04+/-4.86 compared with 6.38+/-3.87 and 6.55+/-2.6 pmol/l respectively), but OPG levels, either at 1 h or 1-4 weeks after AMI, remained significantly (P<0.05) higher compared with established CAD (4.92+/-1.65 pmol/l) and controls (3.15+/-1.01 pmol/l). Our data show for the first time that OPG levels are increased in ST elevation AMI within 1 h of infarction. Whether the increase in OPG is a consequence or a causal factor of plaque destabilization deserves further investigation.

Aged↗
PubMed2005

[Atrial septal aneurysm: a true embolic source?].

Atrial septal aneurysm (ASA) is a well-recognized cardiac abnormality of uncertain clinical significance. It has early been reported as an unexpected finding during autopsy, but it may also be diagnosed in living patients by echocardiographic techniques. An association between ASA and focal cerebral ischemic events has been suggested. Nevertheless, the role of ASA as a risk factor for cerebral ischemia is poorly defined. Several studies have demonstrated a significantly higher proportion of ASA in the patients referred for transesophageal echocardiography after a cerebral ischemic event of unknown cause. However, ASA is often associated with other cardiac abnormalities such as patent foramen ovale, atrial septal defects, as well as mitral valve prolapse or atrial arrhythmias. Due to the fact that these abnormalities are also possible sources of cardiac emboli it is even more difficult to assess the embolic potential of an ASA, independently. In this review, we have examined most of the papers on this topic to try to define the prevalence of ASA in the stroke patients and how this abnormality could be a risk factor for recurrences of cerebrovascular events.

Brain Ischemia↗
PubMed2005

Quadricuspid aortic valve: a rare cause of aortic insufficiency diagnosed by doppler echocardiography. Report of two cases and review of the literature.

Quadricuspid aortic valve is an uncommon congenital valve disease mostly occurring as isolated lesion or sometimes in association with truncal anomalies. Approximately 50% of patients with quadricuspid aortic valve have aortic regurgitation. Before the advent of echocardiography most cases were diagnosed at the time of surgery or at post-mortem examination. We describe 2 cases of patients with quadricuspid aortic valve diagnosed by echocardiography. The first case, a quadricuspid aortic valve with four equal-sized cusps (type A, according to the classification of Hurwitz and Roberts), was identified in a 26-year-old man undergoing echocardiography because of a heart murmur. The second case, a quadricuspid aortic valve with three relatively equal cusps and one smaller cusp (type B, according to the classification of Hurwitz and Roberts), was identified in a 47-year-old man with a history of murmur. The identification and periodical non-invasive evaluation of a quadricuspid aortic valve is important, because such valves are more vulnerable to infection and need adequate prophylaxis against endocarditis.

Adult↗
PubMed2003

Nonpharmacologic care of heart failure: counseling, dietary restriction, rehabilitation, treatment of sleep apnea, and ultrafiltration.

The prognosis of patients with chronic congestive heart failure (CHF) depends not only on pharmacologic therapy but also on nonpharmacologic aspects. A complete and ongoing education program for treating CHF includes an understanding of the causes of CHF, symptoms, diet, salt and fluid restriction, drug regimen, compliance, physical and work activities, lifestyle changes, and measures of self-control. Moreover, the nonpharmacologic treatment (dietary modifications, lifestyle, physical exercise, and health care education) must be inserted in a multidisciplinary program organized by the physician in conjunction with the health system, the nurses, and, especially, the patients themselves, who must understand their disease and the many therapeutic options. Cardiologists should treat patients in a clear and comprehensible way, and other specialists (dietitians, physiotherapists, psychologists, nurses, and social workers), together with the patient's family, should strive for the best living conditions for the patient. In this way, the treatment of CHF can improve the quantity and quality of life and save a significant amount in health care costs.

Counseling↗
PubMed2003

Anatomical M-mode: an old-new technique.

The M-mode (motion mode) technique has improved the diagnostic possibilities of echocardiography due to its high temporal resolution. The use of a two-dimensional (2D) image as a basis for M-mode analysis at a defined line, independent of the transducer orientation, namely the anatomic M-mode (AMM), has been proposed from the beginning of 2D echocardiography. For several years, however, this could not be accomplished due to several reasons including the limited digital memory, the relatively rough pixels of 2D images, and the low temporal resolution of the screen. The AMM has been improved by the "fully digital" machines. These are able to provide a series of digital data (direction, position, and timing) relative to any single echo received from any point of the tissue. AMM analysis, thus, can be performed in any direction, as a "normal" monodimensional echocardiogram. With respect to traditional M-mode, AMM permits a more detailed analysis of cardiac chambers diameters obtained by linear measurements, regional wall motion of the left ventricle (both at rest and during stress), and location of accessory pathways. In particular, the assessment of left ventricular regional wall motion represents the most important goal of this new technique, which results in marked reduction or even elimination of the limitations due to the subjective character of wall motion evaluation with 2D echocardiography.

Echocardiography↗
PubMed2003

Mid-ventricular paradoxical dynamic obstruction in a right-sided secondary hypertrophic cardiomyopathy.

Isolated right ventricular (RV) hypertrophy is a common diagnosis at echocardiography. Mid-ventricular obstructive involvement represents however a really unusual finding. Currently available studies on right-sided hypertrophic cardiomyopathy, regardless of whether they are associated with RV outflow tract obstruction, are usually limited to single cases. Besides, there is still no agreement about the clinical relevance and management of RV hypertrophy. In the present study the authors describe the echocardiographic findings of a patient presenting with RV hypertrophy in whom a rare coexistence of both fixed RV outflow tract and intraventricular dynamic obstruction was observed. Some functional effects of verapamil treatment are also discussed.

Cardiomyopathy, Hypertrophic↗
PubMed2002

Comparison between transesophageal echocardiography and transthoracic echocardiography with harmonic tissue imaging for left atrial appendage assessment.

BACKGROUND: Transesophageal echocardiography (TEE) is the method of choice for evaluating both anatomy and function of left atrial appendage (LAA). In contrast, conventional transthoracic echocardiography (TTE) does not result in images of sufficient quality to explore LAA. HYPOTHESIS: The aim of this study was to evaluate the potential role of TTE with harmonic frequency imaging (HFI) for assessing LAA normal anatomy and function. METHODS: The study group comprised 25 patients, (9 men, 16 women, mean age 51 years, range 20-82). The TTE as sessment of LAA both in fundamental frequency imaging (FFI) and HFI was performed using the apical two-chamber view, the longitudinal two-chamber view was used for TEE assessment of LAA. According to image quality, images were categorized into three classes: A: good quality, B: sufficient quality, C: poor quality. RESULTS: Transthoracic echocardiography conventional imaging allowed sufficient LAA visualization (class B) in only 5 of 25 patients (20%); the HFI resulted in adequate LAA visualization in 23 of 25 patients (92%). Images were of good quality (class A) in 18 of 23 patients and of sufficient quality (class B) in 5 of 23 patients. Transesophageal echocardiography achieved good quality images in 24 of 25 patients (96%). Average LAA maximum area determined by HFI and TEE was 3.46 +/-1.17 and 3.59 +/- 1.16 cm2, respectively; LAA minimum area was 1.81 +/- 0.98 and 1.77 +/- 0.97 cm2, respectively. Percent LAA area change was 51 +/- 16.5 and 50.9 +/- 16% with HFI and TEE, respectively. Statistical analysis showed no difference between the data obtained with the two methods. CONCLUSIONS: The results suggest that HFI TNE may be a useful tool for the exploration of LAA.

Adult↗
PubMed2002

[Coronary microembolization in acute coronary syndrome: indicative hypothesis or still unknown phenomenon? Description of a clinical case].

Acute myocardial infarction may result from rupture or fissuring of atherosclerotic plaque in a coronary artery. Sometimes a different pathogenesis occurs like microembolization following lysis from ulcerated plaque or during pharmacological or interventional procedures. We describe a patient with anterior myocardial infarction treated with alteplase + abciximab (TIMI 14). At the end of thrombolytic therapy administration, we observed a marked reduction of anterior ST elevation associated with a simultaneous occurrence of ST elevation in the inferior leads, later followed by inferior Q waves. The coronary angiogram demonstrated an isolated 60% stenosis on the left anterior descending artery. This case raises the question on whether the very effective and aggressive thrombolytic treatment was paradoxically responsible for microembolization resulting in myocardial infarction extension.

Acute Disease↗