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Biomedical subjects

Gianfranco Butera

Publications and source records attributed to Gianfranco Butera.

At least 37 records · Page 2Linked to original sources
PubMed2005

What do parents know about the malformations afflicting the hearts of their children?

Traditionally, medical professionals have entrusted the parents of children with chronic illness with the task of imparting knowledge about the illness to the children. This practice assumes that parents understand the illness, and that they pass on their knowledge in a manner appropriate for the individual child. The aim of our study was to assess the knowledge that parents of children with a cardiac defect have about the malformation in the heart of their child. We sent a modified version of the Leuven questionnaire to 350 families. The questionnaire was filled in and sent back to our centre by 148 families. Parents showed a good knowledge of the name and anatomical characteristics of the cardiac disease suffered by their child. Parents with a child taking drugs were not very knowledgeable about the regime, side effects, and interaction with other drugs or food. Only one-quarter of the parents knew the definition of endocarditis, although almost two-fifths were aware that unexplained fever for more than 5 days was the most typical symptom. Less than half of the parents knew that endocarditis could recur. About two-fifths of parents knew the real possibility of their child being involved in competitive sports; but almost half of parents were unable to answer this question. The poor knowledge about particular aspects of the disease, treatment, and preventive measures revealed by our parents may have major consequences. The results of our study are relevant to general daily clinical practice.

Child↗
PubMed2005

Patent foramen ovale in scuba divers. A report of two cases and a brief review of the literature.

Scuba diving (diving with a self-contained underwater breathing apparatus) has become a popular sport. Decompression illness may be due to the formation of gas bubbles in various body tissues at an increased ambient pressure. The gas can pass from the systemic venous circulation into the arterial circulation as a result of either pulmonary barotrauma or intravascular shunting. Gas emboli may be the cause of an increased prevalence of brain lesions in sport divers. The management of scuba divers (professionals and amateurs) with a patent foramen ovale is not clear. We present the cases of 2 subjects with decompression illness and a patent foramen ovale and briefly review the literature on this combination.

Adult↗
PubMed2005

Illness understanding in adults with congenital heart disease.

BACKGROUND: Adult patients with congenital heart disease need information regarding their clinical diagnosis, medications and side effects, endocarditis prophylaxis, reproductive issues, employment, future surveillance, treatments, and possible reoperations. Accurate understanding of chronic illness in these patients is associated with less distress, less confusion, improved satisfaction with medical care, better compliance with treatment, and a better emotional status, all key factors for good health-related quality of life. The aim of the present study was to assess the level of knowledge that adult patients with congenital heart disease followed in our Center have about their heart condition. METHODS: A questionnaire on knowledge about congenital heart disease was sent by mail to 200 adults affected by a cardiac congenital disease chosen randomly from all patients regularly followed in our department. RESULTS: Patients had good knowledge about the treatment received, the importance of follow-up, the prognosis of their condition, and the possibility of taking part in physical activities. The patients receiving drug treatment were moderately knowledgeable about their treatment. The anatomy of the heart defect, factors contributing to the onset of endocarditis, the impact of smoking and alcohol, and the possible inheritance of the heart condition were poorly understood by the patients. Most of female patients knew that the oral contraceptive pill was the most appropriate method of birth control; most of them were aware that pregnancy would cause additional risks to their health. Multiple logistic analysis showed that four correct answers were related to the age of the patient. CONCLUSIONS: Overall the results indicated that the educational efforts of all the staff (physicians and nurses) have given encouraging results, but there are still significant gaps in knowledge that need more educational work.

Adult↗
PubMed2004

Patients operated for tetralogy of fallot and with non-sustained ventricular tachycardia have reduced heart rate variability.

BACKGROUND: To study heart rate variability (HRV) in patients operated for tetralogy of Fallot (ToF) and to identify any correlation between HRV and ventricular tachycardia (VT). PATIENTS AND METHODS: We studied HRV in 23 consecutive patients operated for ToF (mean age 14 +/- 6.6 years; mean follow-up 10.6 +/- 5.2 years). Seven patients had non-sustained VT on Holter monitoring. Two control groups were included: 18 healthy subjects and 15 patients operated for other congenital heart disease. There were no differences in age, age at surgery (in the operated groups), follow-up, and mean heart rate between the three groups. Four time and four frequency domain indices were calculated: mean duration of RR intervals, standard deviation of all RR intervals (SD), square root of the mean squared differences of successive RR intervals (r-MSSD), percent of differences between adjacent RR intervals (pNN50), total power (TP), low frequency (LF), high frequency (HF), and LF/HF ratio. RESULTS: HRV indices were identical in the two control groups but were significantly reduced in patients with ToF. Within the patients who had been operated on for ToF, HRV indices were significantly lower in the seven with non-sustained VT than in those without arrhythmias: SD (95 +/- 15 vs. 135 +/- 54 ms; p = 0.01), r-MSSD (26 +/- 9 vs. 45 +/- 20 ms; p = 0.03), pNN50 (4.4 +/- 3.4 vs. 16.5 +/- 12.5%; p = 0.001) and HF (111 +/- 97 vs. 352 +/- 291 ms(2); p = 0.009). Using stepwise multivariate regression analysis, pNN50, age at surgery, degree of pulmonary regurgitation and higher right/left ventricular ratio were independent predictive variables for VT (p < 0.0001; r(2) = 0.85). CONCLUSIONS: ToF patients, particularly those with ventricular arrhythmias, have significant impairment of sympatho-vagal balance, characterized by a reduction of vagal drive.

Adolescent↗
PubMed2004

CardioSEAL/STARflex versus Amplatzer devices for percutaneous closure of small to moderate (up to 18 mm) atrial septal defects.

BACKGROUND: The Amplatzer septal occluder (ASO) allows the percutaneous closure of small to very large atrial septal defects (ASDs). The CardioSEAL/STARflex (CS/SF) can be used only for closure of small to moderate ASDs (stretch size up to 18 mm). These 2 devices are widely used in clinical practice. Therefore, a comparison of their use in the closure of small to moderate ASDs is needed. METHODS: From December 1996 to September 2002, 274 consecutive patients (mean age 20.3 +/- 17 years) underwent percutaneous closure of small to moderate ostium secundum ASDs. The CS/SF device was used in 121 patients, and the ASO was used in 153. RESULTS: There were no differences in age, sex ratio, or pulmonary/systemic flow ratio. Stretch size of the defect was higher in the ASO group (13.6 +/- 3.5 mm vs 15.5 +/- 3.2 mm, P <.001). Procedure time and fluoroscopy time were shorter in patients treated with the ASO (61 +/- 21 vs 75 +/- 32 min, P <.0003, and 11.6 +/- 9 vs 23.8 +/- 17.4 min, P <.0001, respectively). Residual shunt at procedure and discharge was significantly more frequent in the CS/SF group (P <.0001). There were no differences in the complication rate for the 2 groups (CS/SF 4/121 vs ASO 6/153). Length of follow-up was longer in the CS/SF group (24 +/- 14 vs 16 +/- 9 months, P =.0001). Residual shunting was significantly more frequent in the CS/SF group during follow-up, while closure rate reached 100% after 1 month in ASO group. CONCLUSIONS: The 2 devices are clinically safe and effective in ASD closure. However, percutaneous closure of small to moderate ASDs with ASO is quicker and provides an higher rate of complete occlusion.

Adolescent↗
PubMed2004

The care of adult patients with congenital heart defects: a new challenge.

The aim of the present article was to point out some of the more common challenges and needs for adult patients with congenital heart defects. We may reasonably calculate a population approximating 80,000 to 100,000 patients in Italy. The profile of this patient population will change over the next few decades. Not all congenital heart defects require the same level of expertise; for this reason an integrated national service is required. Ideally, specialist units should be established in appropriate geographic areas; complex patients need to be grouped according to the expertise, experience and management they require. Less specialized regional centers and outpatient clinics in interconnected districts with GUCH units should be created. Specialist units should accept responsibility for educating the profession, training the specialists, and sharing particular skills between each other. The debate on this subject is far from over; we wish to contribute to and stimulate the discussion.

Adult↗
PubMed2003

Transcatheter closure of atrial septal defect in young children: results and follow-up.

OBJECTIVES: This study sought to analyze the safety, efficacy, and follow-up results of percutaneous closure of secundum atrial septal defect (ASD) in young children. BACKGROUND: Results of ASD transcatheter closure in adults are widely reported but there are no large published series concerning young children. METHODS: Between December 1996 and February 2002, 48 of 553 patients percutaneously treated at our institution were children age <or=5 years. Indications for closure were: elective closure in 32 patients; frequent respiratory infections in 8; failure to thrive in 2; liver transplantation in 5; and a fenestrated Fontan in 1. The procedure was carried out under general anesthesia with fluoroscopy and transesophageal control. Two different devices were used: 1) the CardioSEAL/StarFLEX (CS/SF) and 2) the Amplatzer septal occluder (ASO). Basal physical examinations and echocardiograms were performed prior to the procedure and at follow-ups (1, 6, and 12 months, and yearly thereafter). RESULTS: The mean age at closure was 3.6 +/- 1.3 years. A CS/SF was used in 10 subjects; an ASO was used in 38 patients. No deaths or immediate major complications occurred. The total occlusion rate was 87% at procedure, rising to 94% at discharge. The mean follow-up was 18 +/- 14 months. No midterm major or minor complications occurred. The occlusion rate rose to 100% at 12 months of follow-up. Symptomatic patients improved significantly. CONCLUSIONS: In the current era and in experienced hands, ASD closure can be performed safely and successfully, even in very young children.

Age Factors↗
PubMed2003

Echocardiographic assessment of overt or latent unexplained pulmonary hypertension.

Primary (idiopathic or unexplained) pulmonary hypertension is a rare disease of the pulmonary vasculature characterized by sustained elevation of pulmonary artery pressure, normal pulmonary artery wedge pressure and absence of secondary causes. Because of the nonspecific nature of early symptoms and physical findings, the diagnosis, essentially one of exclusion, is often made in the later stages of primary pulmonary hypertension. Echocardiography, providing an accurate noninvasive estimate of pulmonary pressure at rest and during exercise, is an essential component in the initial assessment and serial evaluation of patients with primary pulmonary hypertension. Furthermore, it is important to monitor the efficacy of specific therapeutic interventions, to estimate the prognosis and to detect preclinical stages of this disease.

Echocardiography↗
PubMed2003

Surgical treatment of tricuspid valve dysplasia in the neonatal period.

Tricuspid valve dysplasia, other than Ebstein's anomaly, is a very rare congenital heart defect. During the prenatal and/or the neonatal periods the clinical picture is very critical. We here report on a newborn infant with severe tricuspid valve dysplasia and 4/4 tricuspid regurgitation, giant right atriomegaly, functional pulmonary atresia with ductal-dependent pulmonary blood flow. The child was successfully submitted to implantation of a 15 mm pulmonary stentless heterograft valve using the top-hat technique.

Cardiopulmonary Bypass↗
PubMed2003

Range of pulmonary artery pressures in patients undergoing percutaneous atrial septal defect device closure.

The secundum type of atrial septal defect is one of the most common conditions associated with pulmonary arterial hypertension. In a series of 274 consecutive patients who have undergone percutaneous atrial septal defect device closure at our institution we observed an increase in pulmonary artery pressure with age, but only three patients had overt pulmonary arterial hypertension.

Adolescent↗
PubMed2003

The interpretation of the electrocardiogram in patients with pulmonary hypertension: the need for clinical correlation.

BACKGROUND: The detection and treatment of pulmonary hypertension have become increasingly important for the clinician. While the electrocardiogram is often used as a screening tool in patients suspected of having pulmonary hypertension, the sensitivity for detecting right ventricular hypertrophy in the era of computerized electrocardiogram analysis is highly suspect. The aim of the study was to determine the importance of clinical information in providing an accurately edited electrocardiographic system. METHODS: The interpretation of the electrocardiograms of 64 consecutive symptomatic patients (12 males, 52 females, mean age 43 +/- 13 years) with isolated pulmonary hypertension provided by the computer program and the cardiologist following editing during routine daily reading sessions were reviewed. The reader (blinded cardiologist) was unaware of the clinical diagnosis. Subsequently, a cardiologist given clinical information regarding age and symptoms, edited the computer interpretation. RESULTS: The unblinded cardiologist diagnosed right axis deviation > 90 degrees, right ventricular hypertrophy, right ventricular strain, and right atrial enlargement in 76.6, 78.1, 71.9 and 20.3% of patients, respectively. In 6 (9.4%) patients, the electrocardiogram was normal. The blinded cardiologist and computer program diagnosed right ventricular hypertrophy in 43.8 and 39.1% respectively and most often characterized right ventricular strain as non-specific or inferior or as antero-lateral ischemia. CONCLUSIONS: The electrocardiogram has a high degree of sensitivity for the detection of abnormalities in symptomatic patients with isolated pulmonary hypertension. Correlation with the clinical parameters is essential to optimize the usefulness of the electrocardiogram. Consideration should be given to tailoring computerized electrocardiogram interpretative software to clinical information.

Adolescent↗
PubMed2002

Early and late complications associated with transcatheter occlusion of secundum atrial septal defect.

OBJECTIVES: The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure. BACKGROUND: Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices. METHODS: Between December 1996 and January 2001, 417 patients (mean age: 26.6 +/- 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients. RESULTS: Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later. CONCLUSIONS: Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.

Adolescent↗