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Mauro Pepi

Publications and source records attributed to Mauro Pepi.

17 recordsLinked to original sources
PubMed2006

Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse.

OBJECTIVES: The aim of this study, undertaken in patients who underwent mitral valve (MV) repair surgery, was to evaluate the feasibility and accuracy of 3-dimensional (3D) transthoracic (TTE) and transesophageal (TEE) echocardiography in the evaluation of MV pathology. BACKGROUND: A pre-operative assessment of MV anatomy is essential to surgical design in patients undergoing MV repair. Although 2-dimensional (2D) echocardiography provides precise information regarding MV anatomy, 3D TTE and 3D TEE could increase the understanding of MV apparatus and individual scallop identification. METHODS: One-hundred-twelve consecutive patients with severe mitral regurgitation due to MV prolapse underwent a complete 2D and 3D TTE the day before surgery and a complete 2D and 3D TEE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. RESULTS: Three-dimensional techniques were feasible in a relatively short time (3D TTE: 7 +/- 4 min; 3D TEE: 8 +/- 3 min), with good (3D TTE 55%; 3D TEE 35%) and optimal (3D TTE 21%; 3D TEE 45%) imaging quality in the majority of cases. Three-dimensional TEE allowed more accurate identification (95.6% accuracy) of all MV lesions in comparison with other techniques. Three-dimensional TTE and 2D TEE had similar accuracies (90% and 87%, respectively), whereas the accuracy of 2D TTE (77%) was significantly lower. CONCLUSIONS: Three-dimensional TTE and TEE are feasible and useful methods in identifying the location of MV prolapse. They were superior in the description of pathology in comparison with the corresponding 2D techniques and should be regarded as an important adjunct to standard 2D examinations in decisions regarding MV repair.

Aged↗
PubMed2006

Comparison of feasibility and accuracy of transthoracic echocardiography versus computed tomography in patients with known ascending aortic aneurysm.

Aortic valve diseases, hypertension, and connective tissue disorders may be causes of ascending aortic aneurysms. Aortic enlargement monitoring is essential for surgical timing and for operative design. In this regard, several imaging techniques may have limitations: magnetic resonance is not widespread and is expensive, computed tomography uses radiation, and transesophageal echocardiography is a semi-invasive method. The aim of this study was to analyze the feasibility of transthoracic echocardiography in the evaluation of aortic dimensions and its accuracy in comparison with multidetector computed tomography. In 44 patients with known ascending aortic aneurysms, transthoracic echocardiographic and computed tomographic measurements were obtained and compared at different levels: the annulus, sinuses of Valsalva, sinotubular junction, ascending aorta, and aortic arch. Transthoracic echocardiographic diameters were obtained in all patients, apart from the aortic arch, which was measured in 40 cases. Transthoracic echocardiographic and computed tomographic diameters correlated significantly (p <0.001), with very small SEEs: for the annulus, r = 0.846 (SEE 0.37); for the sinuses of Valsalva, r = 0.967 (SEE 0.35); for the sinotubular junction, r = 0.965 (SEE 0.33); for the ascending aorta, r = 0.976 (SEE 0.41); and for the aortic arch, r = 0.87 (SEE 0.50). In conclusion, transthoracic echocardiography is a feasible and accurate technique for the assessment and follow-up of thoracic aortic diameters in patients with ascending aortic aneurysms.

Aged↗
PubMed2006

Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function.

The evaluation of right ventricular (RV) systolic function is important for its clinical and prognostic value but difficult to obtain due to RV complex anatomy. Aims of this study were to evaluate the feasibility of a routine use of RV fractional shortening area (FSA), systolic excursion (TAPSE) and peak systolic velocity (PSV) of tricuspidal annular motion in a large series of cases (900 pts), to determine the values in normal subjects (150) and in patients (750) with different pathologies and to correlate these indexes to clinical and echo-Doppler variables. FSA (50.3+/-10% vs 54.6+/-9% p<0.01), TAPSE (20.2+/-5 vs 24.7+/-4 mm, p<0.01) and PSV (16.2+/-4 vs 20+/-4 cm/s, p<0.01) were lower in patients than in normals, correlated positively to left ventricular ejection fraction and negatively to the pulmonary pressure. The values of 17 mm for TAPSE, 12 cm/s for PSV and 37% for FSA identified patients with high specificity. The values in subgroups of pathological patients were evaluated and compared.

Echocardiography, Doppler↗
PubMed2006

Hyperoxemic perfusion of the left anterior descending coronary artery after primary angioplasty in anterior ST-elevation myocardial infarction.

OBJECTIVES: To assess left ventricle function recovery, ST-segment changes, and enzyme kinetic in ST-elevation myocardial infarction patients treated with intracoronary hyperoxemic perfusion (IHP) after primary percutaneous coronary intervention and compare them with the results obtained in control patients. BACKGROUND: IHP has been shown to attenuate microvascular reperfusion injury, which may result in poor LV function recovery despite successful primary percutaneous coronary intervention. METHODS: Twenty seven anterior ST-elevation myocardial infarction patients treated < or = 12 hr after symptom onset by primary percutaneous coronary intervention were subjected to selective IHP into the left anterior descending coronary artery for 90 min. They were compared with 24 anterior ST-elevation myocardial infarction control patients matched in clinical and angiographic characteristics and treated with conventional primary percutaneous coronary intervention. Left ventricular function recovery was evaluated by serial 2D contrast echocardiography. RESULTS: Left anterior descending coronary artery recanalization was successful in all patients. After IHP (100% successful, duration 90 +/- 5.4 min), patients showed a 4.8 +/- 2.2 hr shorter time-to-peak creatine kinase release (P = 0.001), a shorter creatine kinase half-life period (23.4 +/- 8.9 hr vs. 30.5 +/- 5.8 hr, P = 0.006), and a higher rate of complete ST-segment resolution (78% vs. 42%, P = 0.01). A significant improvement of mean left ventricular ejection fraction (from (44 +/- 9)% to (55 +/- 11)%, P < 0.001) and wall motion score index (from 1.77 +/- 0.2 to 1.39 +/- 0.4, P < 0.001) was observed at 3 months in IHP patients only. CONCLUSION: After successful primary coronary intervention, IHP is associated with significant left ventricular function recovery when compared to conventional treatment. Enzyme kinetic and ST-segment changes suggest faster and more complete microvascular reperfusion and may explain the salutary effects of this new therapy on left ventricular function.

Aged↗
PubMed2006

Echocardiography in the diagnosis and management of pericardial disease.

This review covers the role of echocardiography in the diagnosis and management of the main pericardial disorders. The sensitivity of echocardiography in detecting pericardial fluid is very high and this technique allows the detection of effusion as well as the definition of the size of effusion (small, moderate and severe). The evaluation of the pericardial sac should be carefully performed through all the echocardiographic windows, differentiating diffuse from loculated (regional) effusions. Several echocardiographic and Doppler signs allow an accurate diagnosis of cardiac tamponade. The role of echocardiography is extremely important in atypical clinical presentation such as in patients in the postoperative period after cardiac surgery. Moreover, drainage of the effusion is mandatory in the presence of cardiac tamponade and in this regard echo-guided pericardiocentesis is the gold-standard method. Finally this review covers the echocardiographic diagnosis of pericardial cysts and masses and constrictive pericarditis.

Cardiac Surgical Procedures↗
PubMed2005

Feasibility and diagnostic accuracy of quantitative assessment of mechanical prostheses leaflet motion by transthoracic and transesophageal echocardiography in suspected prosthetic valve dysfunction.

Transthoracic (TTE) and transesophageal echocardiography (TEE) are the standard techniques for the evaluation of prosthetic valve function. However, quantitative evaluation of leaflet(s) motion is not routinally carried out, although leaflet(s) opening and closing angle measurements are important information to recognize prosthetic dysfunction. For this purpose, cinefluoroscopy is considered the "gold standard" technique. The aim of this study was the evaluate the diagnostic accuracy of TTE and TEE in the quantitative assessment of leaflet motion in patients with mechanical protheses. One hundred-eleven patients with mitral (single disk 18; bileaflet 48) and aortic (single disk 22; bileaflet 23) prostheses, were referred to TTE, TEE, and cinefluoroscopy for electrical cardioversion of atrial fibrillation (n = 40) or suspected prosthesis dysfunction (n = 71). Echocardiographic evaluation included leaflet(s) opening and closing angle measurements; results were compared with cinefluoroscopy. For mitral prostheses, opening and closing angles were correctly identified by TTE in 85% and by TEE in 100% of patients, regardless of prosthetic valve type, with a good concordance with cinefluoroscopy. For aortic prostheses, opening angles were correctly identified by TTE and TEE, respectively, in 40% and 77% of patients with single-disk and in 13% and 35% of patients with bileaflet prostheses. Both TTE and TEE were rarely able to identify closing angles. In conclusion, quantitative evaluation of mitral leaflet(s) motion may be accurately achieved with TTE and TEE, leading to increased diagnostic efficacy of prosthetic valve dysfunction. In the aortic position, TTE and TEE allow a quantitative evaluation of leaflet(s) dynamics only in a minority of patients and cinefluoroscopy still remains the first-choice technique.

Aortic Valve↗
PubMed2004

Usefulness of three-dimensional echocardiographic reconstruction of the Amplatzer septal occluder in patients undergoing atrial septal closure.

Eighty-eight patients referred for transcatheter closure of atrial septal or patent foramen ovale defects underwent 3-dimensional transesophageal echocardiography to correlate preclosure anatomy with the morphology and positioning of the atrial septal occluder. Despite the effectiveness of the trancatheter closure and absence of complications, 2 linear indentations of the aortic root by the 2 discs of the device were clearly demonstrated in 16 cases, suggesting caution in the choice of very large occluders.

Adult↗
PubMed2004

Incidence and characteristics of left ventricular false tendons and trabeculations in the normal and pathologic heart by second harmonic echocardiography.

We sought to review echocardiographic incidence of anomalous images (AI) as false tendons and trabeculations of the left ventricle (LV) in light of recent advancements in echocardiographic evaluation of heart anatomy. In 1580 patients the presence of false tendons, trabeculations, or thrombi was evaluated with transthoracic echocardiography and correlated to clinical characteristics and echocardiographic parameters. Incidence of AI was 46.7% (75% false tendons, 23% trabeculations, 2% thrombi), slightly higher in pathologic (48.9%) than in normal hearts (40.8%). AI were more frequent in male patients (52%) than in female patients (39.7%) and associated with LV dilatation, hypertrophy, and systolic dysfunction. False tendons and trabeculations were not related to age. Male sex was the most significant independent predictor of AI. In 2 patients, isolated LV noncompaction of myocardium was diagnosed and confirmed by magnetic resonance imaging. This study shows a high prevalence of AI for patients with and without pathologic hearts suggesting the need of updating LV echocardiographic anatomy. It also emphasizes the necessity for an awareness of these anatomic variants when evaluating patients for mural thrombi and cardiomyopathies.

Adolescent↗
PubMed2003

Prosthetic mitral valve thrombosis: can fluoroscopy predict the efficacy of thrombolytic treatment?

BACKGROUND: Thrombolysis (T) is an effective therapy for prosthetic valve thrombosis (PVT). Debate still exists as to which clinical or noninvasive finding best predict the result of T. The aim of the study was to investigate the role of fluoroscopy (F) to predict efficacy of T in pts with mitral PVT. METHODS: We evaluated 17 consecutive pts with bileaflet mitral PVT. F criteria for PVT were: abnormal disc motion and calculated opening angle >25 degrees. T was carried out with tissue-type plasminogen activator (tPA; 100 mg over 3 hours followed by heparin infusion for 24 hours) and was considered successful when normalization of leaflet motion and opening angle occurred. Results were evaluated according to symptom duration (<21 days, early PVT; >21 days, late PVT) and to F pattern of PVT (blocked leaflet versus hypomobile leaflet). RESULTS: F showed disc motion alteration in 24 of 34 leaflets: 8 leaflets were blocked, whereas 16 were hypomobile. Early (12.7+/-6.1 days, range 3-21) and late (113+/-114 days, range 28-365) PVT was present in 8 and 7 pts, respectively. Thrombolysis was successful in 20 of 24 leaflets. Blocked leaflet fully recovered only in early PVT (n=4) pts, whereas they remained blocked in late PVT (n=4). On the contrary, in all of the cases with hypomobile leaflet, disc motion normalized regardless duration of symptoms and extent of disc motion reduction. Interestingly, 4 leaflets with late PVT was diagnosed as blocked by trans-thoracic (TTE). F showed a residual disc movement in all: they fully recovered after T. Two pts with late PVT had both leaflets affected (1 blocked +1 hypomobile); although blocked leaflet did not respond to T, the normalization of hypomobile significantly improved clinical condition. CONCLUSIONS: F can predict result of T in mitral PVT. PVT with F evidence of hypomobile leaflet always recovers regardless of symptom duration and extent of disc motion reduction, suggesting that the small amount of thrombus needed to interfere with discs motion in bileaflet prostheses remains sensitive to T even after a long time. PVT with F evidence of blocked leaflet has a favorable response to T only in case of early PVT. Late PVT with blocked leaflet does not respond to T, suggesting a larger and stratified thrombus and the coexistence of pannus and, in our series, always required surgery. However, if a hypomobile leaflet coexists, T may be used to restore normal movement of hypomobile leaflet so that to improve patient clinical and hemodynamic condition before operation.

Echocardiography, Doppler↗
PubMed2003

Effects of acute angiotensin-converting enzyme inhibition on diastolic ventricular interaction in the dilated heart.

BACKGROUND: The normal and dilated heart behaves as a single functional unit during preload reduction: volume unloading in the setting of diastolic ventricular interaction allows for increased left ventricular (LV) filling. HYPOTHESIS: We hypothesized that reduction of venous return induced by a physiologic stimulus (tilting) or by acute angiotensin-converting enzyme (ACE) inhibitors in dilated heart is likely to have a marked and similar effect on ventricular chamber geometry and filling. This study was designed to assess how the normal and dilated heart adapts to preload reduction. METHODS: Twenty normal subjects and 20 patients with moderate heart failure due to dilated cardiomyopathy were studied with two-dimensional and Doppler echocardiography in supine position (B) and after 40 degrees of head-up tilting (T). The following day, patients repeated supine (C) and tilting test (TC) after administration of captopril (25 mg s.l.). Right ventricular (RV) and LV dimensions, LV geometry, and tricuspid, mitral, and pulmonary venous flow patterns were recorded at each step of the study. RESULTS: In the two groups, T was associated with reduction of RV area and LV volumes; C and TC produced a similar effect on RV and LV. Changes in LV septal-lateral diameter and anterior-posterior diameter were different at each step of the study: during T (both groups) and after C and TC, the septallateral diameter increased slightly while the anterior-posterior diameter decreased. During T, mitral and tricuspid peak flow velocities decreased, peak late velocities were unchanged, and the deceleration time of mitral flow increased; the systolic forward flow of pulmonary venous flow decreased, the diastolic forward flow did not change, and the difference in duration between reverse pulmonary flow and mitral peak late flow decreased: C and CT induced similar changes. CONCLUSION: Preload reduction induced by tilting or by ACE inhibitors induces profound and similar effects on LV and RV dimensions, LV geometry, and biventricular filling. Reduction of RV dimension is associated with adaptation of LV geometry and decrease of LV diastolic pressure, which facilitates LV filling and pulmonary venous drainage: ACE inhibition associated with tilting exerts an additional effect on these changes. These data confirm the role of ventricular interaction in modulating LV filling in heart failure.

Adult↗
PubMed2003

Initial experience with a new on-line transthoracic three-dimensional technique: assessment of feasibility and of diagnostic potential.

BACKGROUND: Despite its wide diagnostic potential, three-dimensional (3D) echocardiography is a quite rarely employed technique. The ideal method to obtain transthoracic 3D imaging is on-line 3D echocardiography, but first-generation real-time instruments had technical limitations. A new on-line 3D technology which allows true real-time volume rendering of the cardiac anatomy has been recently introduced and its feasibility and diagnostic advantages have been evaluated in the clinical setting. METHODS: The system utilizes a "matrix" transducer with a dedicated software. It allows instantaneous acquisition and rendering on-line 3D images and interactive manipulation of 3D data. Eighty-three adult patients with various cardiac pathologies underwent on-line 3D echocardiography. Long- and short-axis views of the aorta, mitral valve and left ventricle and surgical views of these structures were attempted. The duration of acquisition and reconstruction, and the quality and incremental clinical value of 3D images in comparison with two-dimensional imaging were annotated. RESULTS: The mean time of 3D examination was 10 +/- 5 min; the mean number of acquisitions was 10.8 per patient. The quality of the 3D images was optimal in 39%, good in 37%, sufficient in 19%, and insufficient in 5% of the patients. In all cases at least one optimal or good live 3D image was obtained from the parasternal and apical views. The reconstruction of surgical or en face views was easily and rapidly (1-2 min) achieved by two experts in 3D echocardiography. The additional clinical values of 3D vs two-dimensional imaging was demonstrated in 7 patients with mitral valve disease, 3 with aortic valve pathology, and 3 with congenital heart disease. Several on-line 3D images that have not correspondence with two-dimensional echocardiography were reconstructed, creating projections dedicated to the diagnostic goal. CONCLUSIONS: On-line 3D echocardiography can be easily performed in adult patients and allows for unique planes and projections. The instant rendering of 3D images facilitates the recognition of cardiac structures and increases the diagnostic potential of transthoracic echocardiography.

Adolescent↗
PubMed2003

Usefulness of multiplane transesophageal echocardiography in the recognition of artifacts and normal anatomical variants that may mimic left atrial thrombi in patients with atrial fibrillation.

BACKGROUND: Transesophageal echocardiography (TEE) is the method of choice for the evaluation of the left atrium and of left atrial appendage (LAA) thrombosis. However, the anatomy of the left appendage is complex and reverberations from anatomical structures may create images and ghosting which mimic left atrial thrombosis. The purpose of this study was to investigate whether a systematic approach through TEE may facilitate the recognition of LAA anatomical variants and artifacts. METHODS: One hundred and sixty-four consecutive patients scheduled for cardioversion of atrial fibrillation (study population) and 30 patients (control group) undergoing mitral valve surgery were submitted to TEE using a multiplane probe in order to obtain a systematic evaluation of the LAA. The number of LAA lobes and the presence of thrombi and artifacts were evaluated. RESULTS: The majority of the study patients had a bilobed (53.1%) or single-lobed (34.1%) LAA. Thrombi were identified in 6%. Artifacts were found in 38 cases (23.2%) and their position was localized precisely at a distance from the transducer which was twice that from the partition-bend between the left upper pulmonary vein and left appendage, suggesting a reverberation. No differences in echocardiographic parameters were found in patients with (group 1) or without (group 2) artifacts. Cardioversion was successful in a similar percentage of cases in the two groups (group 1 68%, group 2 76%) without complications. In controls, the percentages of a single-(33%) and bilobed (40%) left appendage were similar to those found in the study population. Artifacts were identified in 11 controls (37%); no thrombi were detected during surgical left appendage inspection in these cases. CONCLUSIONS: A systematic approach with multiplane TEE facilitates the evaluation of the LAA anatomy and the recognition of artifacts, thus reducing the likelihood of false positive or negative diagnoses of left appendage thrombi.

Adult↗
PubMed2002

Initial experience with hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction: results of a pilot study utilizing intracoronary aqueous oxygen therapy.

OBJECTIVES: The purpose of this study was to evaluate the feasibility and safety of intracoronary hyperoxemic reperfusion after primary angioplasty for acute myocardial infarction (MI). BACKGROUND: Hyperoxemic therapy with aqueous oxygen (AO) attenuates reperfusion injury and preserves left ventricular (LV) function in experimental models of MI. METHODS: In a multi-center study of patients with acute MI undergoing primary angioplasty (PTCA), hyperoxemic blood (pO(2): 600 to 800 mm Hg) was infused into the infarct-related artery for 60 to 90 min after intervention. The primary end points were clinical, electrical and hemodynamic stability during hyperoxemic reperfusion and in-hospital major adverse cardiac events. Global and regional LV function was evaluated by serial echocardiography after PTCA, after AO infusion, at 24 h and at one and three months. RESULTS: Twenty-nine patients were enrolled (mean age: 58.9+/-12.6 years). Hyperoxemic reperfusion was performed successfully in all cases (mean infusion time: 80.8+/-18.2 min; mean coronary perfusate pO(2): 631+/-235 mm Hg). There were no adverse events during hyperoxemic reperfusion or the in-hospital period. Compared with baseline, a significant improvement in global wall motion score index was observed at 24 h (1.68+/-0.24 vs. 1.48+/-0.24, p < 0.001) with a trend toward an increase in ejection fraction (48.6+/-7.3% vs. 51.8+/-6.8%, p = 0.08). Progressive improvement in LV function was observed at one and three months, primarily due to recovery of infarct zone function. CONCLUSIONS: Intracoronary hyperoxemic reperfusion is safe and well tolerated after primary PTCA. These preliminary data support the need for a randomized controlled trial to determine if hyperoxemic reperfusion enhances myocardial salvage or improves long-term outcome.

Aged↗