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Gianfranco Butera

Publications and source records attributed to Gianfranco Butera.

At least 19 recordsLinked to original sources
PubMed2006

A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years.

OBJECTIVES: To compare surgical as opposed to percutaneous interventional closure of isolated atrial septal defects in the oval fossa in terms of hospital stay, efficacy, and complications, and to study the respective role of the two techniques in current practice. METHODS: Between January 1998 and April 2004, 126 out of 1210 patients treated at our institution for closure of an isolated defect in the oval fossa were aged less than 6 years. The mean age of these 126 patients at procedure was 4.2 plus or minus 1 year. The ratio of females to males was 74 to 52. RESULTS: Of the patients, 62% were treated successfully using a percutaneous approach. The groups treated surgically or percutaneously did not differ for age, gender, or indications for treatment. No deaths occurred. The rates of total and major complications were higher in the group undergoing surgical closure, at 34% versus 9%, p less than 0.0001, and 10.5% versus 1%, p equal to 0.01, respectively. Embolisation of the device requiring subsequent surgery occurred in 1% of patients. The stay in hospital was shorter in those closed percutaneously, at 3.2 plus or minus 0.9 days versus 6.8 plus or minus 2.8 days, p equal to 0.0001. During a mean follow-up of 3.4 plus or minus 1.9 years, no major complications occurred in either group, and symptoms improved significantly in both groups. Additional sequels occurred in 2 patients who had major complications subsequent to surgical closure. CONCLUSIONS: Even in young children, it is both feasible and safe to close defects in the oval fossa percutaneously. Compared to surgical closure, the transcatheter approach allows a shorter stay in hospital, and has a lower rate of complications. Early and mid-term follow-up has confirmed the safety and efficacy of both techniques.

Chi-Square Distribution↗
PubMed2006

Percutaneous closure of ventricular septal defects in children aged <12: early and mid-term results.

AIMS: The aim of the article is to study the safety, efficacy, and follow-up of percutaneous closure of muscular ventricular septal defect (mVSD) and perimembranous ventricular septal defect (pmVSD) in children. METHODS AND RESULTS: Between January 2000 and June 2005, among 140 patients who underwent percutaneous closure of an mVSD or a pmVSD, 88 were aged lt;12. Two different Amplatzer devices were used: the mVSD occluder and the pmVSD occluder. Mean age and weight at procedure were 4.5+/-3.3 years and 18.7+/-11.2 kg, respectively. Percutaneous closure was successfully achieved in 83 subjects (94%). No deaths occurred. Thirteen patients (14.7%) had early complications: device embolization (n=4), vascular complications (n=3), and rhythm abnormalities (n=6). These were transient complications in all but one case [1.1% complete atrioventricular block (cAVB) needing pacemaker implantation]. During a median follow-up of 24 months, three subjects treated for a pmVSD needed pacemaker implantation due to the occurrence of cAVB. Multivariable analysis using Cox's proportional hazard regression showed that age was the only risk factor associated with the occurrence of cAVB (P=0.028; relative risk: 0.25). CONCLUSION: Percutaneous closure of mVSD and pmVSD in children can be performed safely and successfully. The occurrence of cAVB is a major concern in young children with pmVSD.

Arrhythmias, Cardiac↗
PubMed2006

The impact of interventional cardiology for the management of adults with congenital heart defects.

The objective of this study is to assess the impact of interventional cardiology procedures for the management of ACHD. The interventional approach to the management of CHD in the adult population is becoming increasingly recognized as the preferred treatment option for a wide number of congenital cardiac conditions. The files of all consecutive patients over 18 years of age who were hospitalized in our department from January 2000 to December 2004 were reviewed. Over the study period, 1,115 ACHD (583 women; mean age 41 +/- 13.8, years, range 18-72 years) were hospitalized in our department; 752 patients underwent cardiac catheterization and 82.4% of them had an interventional procedure carried out. ASD (329/620) and PFO (159/620) closure account for 78% of all the procedures carried out, with a 2.7% of major complications incidence (all of them closing ASDs). Other procedures such as stenting aortic coarctation (40/620), ventricular septal defect closure (33/620), patent ductus arteriosus embolization (30/620), pulmonary valvuloplasty (12/620), stenting pulmonary artery branches (8/620), etc (5/620) were carried out. The most important complication was one death, which occurred in the case of a 22-year-old woman after stent implantation for a recurrent aortic coarctation. A trivial residual shunt was detected in only 5% of the patients who had a 6-month follow-up after VSD closure; no residual shunt was found after PDA embolization during the 12-month follow-up. In conclusion, we believe that the interventional approach is a safe and successful treatment option for a wide number of congenital cardiac conditions. The increasing use of catheter interventions for these patients will be responsible for an increase of complex cases in surgery.

Adolescent↗
PubMed2006

Covered stents in patients with congenital heart defects.

OBJECTIVES: To evaluate the role of covered Cheatham-Platinum stents in patients with congenital heart disease. BACKGROUND: There are limited data in the literature about the use of covered stent in patients with congenital heart disease. METHODS: Between January 2004 and September 2005, covered Cheatham-Platinum stents were implanted into 18 patients with congenital heart defects (9 males, median age 19 years, range 8-45 years). Sixteen had aortic coarctation or recoarctation (8 with associated aneurysm, 1 with patent ductus arteriosus, 3 with an irregular wall, 4 with subatretic native aortic coarctation) (group 1). Two subjects with univentricular heart circulation were treated because of complex right-to-left shunting (Group 2). RESULTS: Group 1: The stents used ranged from 34 to 45 mm in length. The mean fluoroscopy and procedure times were 12+/-8 and 70+/-15 minutes, respectively. After implantation, the gradient across the stenosis decreased significantly (prestent median value 37 mmHg) (range 20-50 mmHg) versus poststent: median value 0 mmHg (range 0-10 mmHg) (P<0.0001). Vessel diameter increased from a median value of 6 mm (range 0-11) to a median value of 14 mm (range 10-23) (P<0.0001). Stents were placed in the correct position in all subjects. No complications occurred and on angiographic control the stenoses had been relieved and the aneurysms completely excluded. Group 2: Implantation of the covered stents successfully abolished right-to-left shunting in both patients. Both had significant increases in oxygen saturation and no complications occurred. FOLLOW-UP: During a median follow-up of 7 months (1-19 months), the results were stable without any complications. CONCLUSION: Covered Cheatham-Platinum stents are very useful tools for treating various congenital cardiovascular malformations.

Adolescent↗
PubMed2006

Expanding indications for the treatment of pulmonary artery stenosis in children by using cutting balloon angioplasty.

OBJECTIVES: To evaluate the role of cutting balloon angioplasty in children with pulmonary artery stenosis. BACKGROUND: Pulmonary artery stenoses can be either congenital or secondary to postoperative scar formation. Isolated multiple small-vessel pulmonary artery stenoses are very rare. No surgical procedures for their treatment are currently available. METHODS: We report on four patients in whom standard and high-pressure balloon angioplasty had failed. Three of the four (2.5-, 3-, and 3.5-years-old; two girls) had isolated multiple peripheral pulmonary artery stenosis. The fourth patient was an 11-month-old girl (8 kg) with tetralogy of Fallot and hypoplastic pulmonary artery branches treated with the implantation of two stents in the pulmonary arteries. During the follow-up this patient developed severe intrastent restenosis and showed severely hypoplasic distal left pulmonary artery. RESULTS: We treated 11 vessels. The mean vessel diameter increased by 81% (P<0.0001) and RV/LV pressure ratio decreased from 1.15 to 0.75 (P=0.05). Patient treated for intrastent restenosis underwent successful complete tetralogy of Fallot repair. None of the patients suffered procedure-related complications. At a median follow-up of 18 months, results were stable and no late complications had occurred. CONCLUSIONS: Cutting balloon angioplasty is a promising technique for the treatment of highly challenging pathologies such as small vessel pulmonary artery stenoses and intrastent restenosis.

Angiography↗
PubMed2006

Late complete atriovenous block after percutaneous closure of a perimembranous ventricular septal defect.

Percutaneous closure of a perimembranous ventricular septal defect (VSD) is an alternative to surgical closure. Complications include arrhythmias and in particular early postoperative complete atrioventricular (AV) block. We report the cases of two patients, aged 2.5 and 4 years, treated with an eccentric VSD occluder device whom developed complete AV block 4 and 12 months after the procedure. The first patient experienced syncope, while the second one was completely asymptomatic. Both subjects underwent endocardial ventricular pacemaker implantation.

Cardiac Catheterization↗
PubMed2006

The "pull-push" technique to deal with a redundant eustachian valve interfering with placement of a PFO occluder.

OBJECTIVES: To evaluate the role of a new technique to deal with a redundant Eustachian valve (EV) interfering with placement of a patent foramen ovale (PFO) occluder. BACKGROUND: The EV is a remnant of the embryonic valve of the sinus venosus. In rare occasions, it is large and redundant and it may interfere with catheters and devices used in cardiac catheterization. METHODS: We have developed a new technique to control the EV in order to avoid interferences with the device for closure of atrial septal defects and PFO's. This technique is called "pull-push" technique and consists in pulling down on the inferior vena cava the redundant EV by using a 6 Fr pigtail catheter while a second operator pushes the right atrial disc out of the long sheath. RESULTS: Here, we report on two patients with a patent foramen ovale, in whom the EV prevented the right atrial disc of an Amplatzer PFO occluder to be completely flat against the interatrial septum. Finally, we used this technique in one more patient to avoid any interference of a very redundant EV during placement of a Starflex device. CONCLUSIONS: In conclusion. the so called "pull-push" technique is an alternative and easy technique to control the EV in order to avoid interferences with the device for closure of atrial septal defects and PFO's

Adult↗
PubMed2006

Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications.

BACKGROUND: Surgical closure of atrial septal defect (ASD) provides excellent results. Given the increasing popularity of percutaneous techniques, a comparison between the 2 methods is needed. METHODS: Between December 1988 and June 2003, we performed 1284 procedures in 1268 consecutive patients with isolated secundum ASD. Five hundred and thirty-three patients underwent surgical repair of ostium secundum ASD (group A). Seven hundred and fifty-one consecutive patients underwent percutaneous ASD closure (group B). The following outcomes were studied: mortality, morbidity, hospital stay, and efficacy. RESULTS: There were no postoperative deaths. The overall rate of complications was higher in group A than in group B: 44% (95% CI 39.8%-48.2%) versus 6.9 % (95% CI 5%-8.7%) (P < .0001). Major complications were also more frequent in group A: 16% (95% CI 13%-19%) versus 3.6% (95% CI 2.2%-5.0%) (P = .002). Multiple logistic regression analysis showed that surgery was independently strongly related to the occurrence of total complication (odds ratio [OR] 8.13, 95% CI 5.75-12.20) and of major complications (OR 4.03, 95% CI 2.38-7.35). The occurrence of minor complications was independently related to surgery (OR 7.33, 95% CI 4.75-11.02), childhood (OR 1.52, 95% CI 1.01-2.34), and presence of systemic hypertension (OR 1.35, 95% CI 1.01-4.41). Hospital stay was shorter in group B (3.2 +/- 0.9 vs 8.0 +/- 2.8 days, P < .0001). CONCLUSIONS: Percutaneous ASD closure provides, in experienced hands and in highly specialized centers, excellent results with a lower complication rate and requires a shorter stay in hospital.

Adolescent↗
PubMed2006

Combined atrial septal defect surgical closure and irrigated radiofrequency ablation in adult patients.

BACKGROUND: Atrial arrhythmias are relatively common among patients over 40 years old with atrial septal defect (ASD) and are a precipitating cause of heart failure. Surgical closure of the ASD in these patients is feasible and is associated with a low mortality rate and a beneficial effect on the clinical status; however the occurrence of atrial arrhythmia does not decrease after surgery. We present the results of our preliminary experience with surgical ASD closure combined with intraoperative irrigated radiofrequency (IRF) ablation in adult patients. METHODS: During a 26-month period between September 2002 and December 2004, 15 patients more than 40 years old with ASD and atrial arrhythmia underwent elective surgical closure of the defect and intraoperative IRF ablation. All patients had supraventricular arrhythmias: 8 had permanent atrial fibrillation, whereas 7 had previous episodes of atrial flutter or intra-atrial reentry tachycardia. The biatrial approach (Cox-Maze III procedure) was used in 7 patients and a right-sided Maze procedure (ablation lines on the right atrium only) was carried out in the remaining 8 patients. RESULTS: All patients survived the procedure. Fourteen patients left the operating room in sinus rhythm and 1 had a pacemaker implanted. There were no complications resulting from the IRF ablation. All 15 patients survived over the average follow-up period of 24 months. Thirteen patients were still in sinus rhythm, 1 had pacemaker rhythm, and only 1 (1 of 15; 6.5%) suffered a recurrence of atrial fibrillation 3 months after the procedure. CONCLUSIONS: We suggest adding intraoperative IRF ablation during surgical closure of an ASD in all adult ASD patients with arrhythmias. The IRF ablation is easy to perform, safe, and effective.

Adult↗
PubMed2006

Percutaneous closure of ventricular septal defects.

Isolated ventricular septal defect is the most common form of congenital heart disease. Surgery has been performed for many years and is considered the gold standard for the treatment of ventricular septal defects. However, it is associated with morbidity and mortality. Less invasive techniques have been developed and currently percutaneous closure of muscular and perimembranous ventricular septal defects has to be considered a possible alternative to the standard surgical approach.

Cardiac Surgical Procedures↗
PubMed2006

Transcatheter treatment of perimembranous ventricular septal defect, secundum atrial septal defect and patent ductus arteriosus in a child.

A 4-year-old child with patent ductus arteriosus, perimembranous ventricular septal defect and ostium secundum atrial septal defect was successfully treated with the use of a simultaneous transcatheter for all of the anomalies present. The patent ductus arteriosus was closed first by using a coil, then the perimembranous ventricular septal defect was closed by using a 10-mm Amplatzer eccentric device. Finally, a 10-mm Amplatzer atrial septal defect device was implanted to treat the atrial septal defect.

Abnormalities, Multiple↗
PubMed2005

Transcatheter closure of congenital ventricular septal defect with Amplatzer septal occluders.

This study reports on experience with transcatheter closure of congenital ventricular septal defects (VSDs) with Amplatzer septal occluders. From January 2000 to April 2005, transcatheter Amplatzer device implantation was attempted in 122 patients with congenital VSD (30 with muscular, 87 with perimembranous, and 5 with residual postsurgical repair of conotruncal malformations). Patient mean age was 15 years (range, 6 months to 64 years), and mean weight was 35 kg (range, 5.8 to 102 kg). The VSD mean size was 7 mm (range, 4 to 16 mm), mean Qp/Qs was 2.1 (range, 1.3 to 4), and mean fluoroscopy time was 32 minutes (range, 5 to 129 minutes). All procedures were performed with the patient under general anesthesia and guided by fluoroscopy and transesophageal echocardiography. The device size chosen was usually 1- to 2-mm larger than the maximum defect size as assessed by either the echocardiographic or angiographic views that were judged most reliable. Amplatzer muscular devices were placed in 47 patients, and the membranous devices were placed in 72 patients. The procedure was not performed in 3 patients with perimembranous VSD because of the impossibility of achieving an adequate long sheath position in 1 patient, onset of complete atrioventricular (AV) block during catheter manipulation in 1 patient, and the presence of aortic valve prolapse preventing a safe device placement in 1 patient. Satisfactory device implantation was achieved in 119 of 122 patients (97.5%): a tiny smoke-like residual flow through the device was often seen immediately after the procedure (50%); residual shunting was detectable in 19% after 24 hours and in only 4% at 6 months. The following additional catheter interventions were performed simultaneously: balloon pulmonary valvuloplasty in 3 patients, device closure of atrial septal defects in 2 patients, coil occlusion of the arterial duct in 1 patient, stenting coarctation in 1 patient, and stenting of the right pulmonary artery in 1 patient. Minimal aortic regurgitation developed in 3 patients, and minimal tricuspid regurgitation in 3 patients; no patient required additional treatment. Device embolization occurred in 3 patients (1 patient with muscular VSD, 2 with perimembranous VSD); catheter retrieval and implantation of a second device was successfully performed in all patients. Transient left bundle branch block occurred in 2 patients, and transient first-degree AV block in 1 patient. Among the perimembranous VSD cases, complete AV block occurred acutely (within 48 hours) in 3 patients, requiring a pacemaker in 1 patient; complete heart block occurred in the other 2 patients after 5 and 12 months, requiring pacemakers. There was no mortality. Transcatheter closure of muscular and perimembranous VSDs offers encouraging results: 96% complete closure at midterm follow-up. Complications are limited; the most relevant appears to be device-related complete heart block in perimembranous VSD. Greater experience and long-term follow-up are required to assess the safety and effectiveness of this procedure as an alternative to conventional surgery.

Adolescent↗
PubMed2005

Results and mid-long-term follow-up of stent implantation for native and recurrent coarctation of the aorta.

AIMS: Since the late 1980s, endovascular stents have been used in the treatment of several vascular lesions. In the last decades, stent implantation has been proposed as a reliable option for the treatment of coarctation of the aorta. In this setting, it seems to have some advantages, rendering it superior to angioplasty alone. METHODS AND RESULTS: Between December 1997 and December 2004, 71 consecutive patients (44 males and 27 females) underwent cardiac catheterization for native or recurrent coarctation of the aorta. Seventy-four stents were implanted. All discharged patients were enrolled in a follow-up programme. Every patient underwent clinical evaluation, echo-colour Doppler studies, and exercise ECG at 1 and 6 months after the stent implantation. Peak systolic gradient dropped from 39.3 +/- 15.3 to 3.6 +/- 5.5 mmHg (P = 0.0041). The diameter of the coarcted segment increased from 8.3 +/- 2.9 to 16.4 +/- 3.8 mm (P = 0.037). In our series, one death occurred in a 22-year-old girl with a recurrent coarctation of the aorta, just after stent implantation. The rate of minor complications was <2%. Re-dilatation of a previously implanted stent was performed in three patients. CONCLUSION: In our experience (the largest reported to the best of our knowledge), stenting of a coarctation/re-coarctation of the aorta represents a safe alternative treatment without a significant mid-long-term complication.

Adolescent↗
PubMed2005

Interventricular septal hematoma in ventricular septal defect patch closure.

We report a case of interventricular septal hematoma after patch closure of a perimembranous ventricular septal defect in a 4-month-old infant. On postoperative day 1, echocardiography showed a voluminous intramural hematoma causing severe thickening of the ventricular septum. Surgical revision was necessary immediately to drain the hematoma.

Echocardiography↗