Marco Morsolini

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

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Andrea Maria D’Armini

University of Pavia

Mario Viganò

University of Pavia

Salvatore Nicolardi

Ospedale Vito Fazzi

Michele Pilato

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Giuseppe Maria Raffa

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Gabriella Mattiucci

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

Cristian Monterosso

Policlinico San Matteo Fondazione

Catherine Klersy

Policlinico San Matteo Fondazione

Giorgio Zanotti

St. Vincent Hospital

Valentina Grazioli

Humanitas Gavazzeni

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione

University of Pavia

Policlinico San Matteo Fondazione

University of Palermo

University of Pittsburgh

Medical University of Vienna

St. Antonius Ziekenhuis

KU Leuven

Inserm

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First-in-human high-density endo-epicardial mapping and ablation through left minithoracotomy in a patient with unstable ventricular tachycardia requiring ECMO

HeartRhythm Case Reports (2020)

Sergio Conti Michele Pilato Antonio Arcadipane Marco Morsolini Marco Turrisi

High-definition (HD) and multielectrode mapping catheters have been introduced in order to perform high-quality activation and substrate map during catheter ablation of complex arrhythmias. A peculiar HD multielectrode mapping catheter is the Advisor HD Grid Sensor Enabled (SE) multipolar mapping catheter (Abbott Medical, Minneapolis, MN), designed with 16 × 1 mm equidistant electrodes (4 splines, 4 electrodes for each spline) with 3 mm electrode spacing that, in combination with the automated HD wave algorithm, allows the rapid assessment of voltage, activation, and directionality of conduction.

Reentry

10.1016/j.hrcr.2020.04.003

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Surgical treatment of primary pulmonary artery sarcoma

Journal of Thoracic and Cardiovascular Surgery (2013)

Valentina Grazioli Nicola Vistarini Marco Morsolini Catherine Klersy G Orlandoni

Pulmonary thromboendarterectomy

Endarterectomy

10.1016/j.jtcvs.2013.07.054

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Citations (49)

Chronic thromboembolic pulmonary hypertension: From transplantation to distal pulmonary endarterectomy

The Journal of Heart and Lung Transplantation (2016)

Andrea Maria D’Armini Marco Morsolini Gabriella Mattiucci Valentina Grazioli Maurizio Pin

Endarterectomy

Thromboembolic disease

10.1016/j.healun.2015.12.029

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Citations (9)

[The PATENT-1 and CHEST-1 studies].

PubMed (2015)

Gavino Casu Laura Scelsi Marco Morsolini Andrea Maria D’Armini

10.1714/1798.19570

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Ipertensione polmonare cronica tromboembolica

Rassegna di patologia dell'apparato respiratorio (2017)

Patrizio Vitulo Marco Morsolini

La ipertensione polmonare cronica tromboembolica (piu nota con l’acronimo CTEPH, Chronic Thrombo-Embolic Pulmonary Hypertension) e una forma di Ipertensione Polmonare (IP) secondaria alla ostruzione tromboembolica cronica del circolo arterioso polmonare, identificata nel gruppo IV della attuale classificazione della ipertensione polmonare. La diagnosi puo essere difficile: nel 75% dei casi e presente almeno un episodio remoto di embolia polmonare acuta, ma spesso dall’episodio acuto all’esordio dei sintomi della CTEPH possono trascorrere anni; talora e presente una condizione di trombofilia. La tecnologia dell’imaging oggi consente di fare diagnosi combinando approccio scintigrafico, TC e angiografico. La terapia di elezione che riporta i migliori risultati e quella chirurgica (Tromboendoarterectomia Polmonare, TEAP): e disponibile in pochi Centri al mondo, uno di questi si trova in Italia. L’indicazione chirurgica dipende dalla sede e dalla tipologia dei difetti endovascolari e viene posta dal chirurgo esperto di TEAP. I risultati finali nei Centri ad alto volume sono ottimi anche a lungo termine. Nei pazienti con CTEPH non operabile e percorribile la terapia medica con riociguat. Nelle forme molto distali non operabili e stato recentemente applicato un approccio terapeutico percutaneo: la dilatazione dei rami arteriosi polmonari con pallone. La diagnosi e la terapia della CTEPH richiedono un approccio pluridisciplinare esperto che vede in pneumologo, cardiologo, radiologo e cardiochirurgo gli attori insostituibili per un programma di successo.

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Functional assessment and quality of life before and after pulmonary endoarterectomy.

PubMed (2016)

Lucia Petrucci Ettore Carlisi S. Ricotti Simona Zanellato Catherine Klersy

The study investigates Quality of Life (QOL) and correlation with functional status of patients affected by Chronic Thromboembolic Pulmonary Hypertension who undergo Pulmonary Endoarterectomy.We investigated with an observational design (before surgery, three and twelve months afterwards) the hemodynamic data (NYHA class, mean pulmonary arterial pressure, cardiac output and pulmonary vascular resistance), the functional status (using the 6-Minute Walk Test) and the QOL, using three questionnaires: Medical Outcome Study Short Form-36 (SF-36), Minnesota Living with Heart Failure Questionnaire (MLHFQ), Saint George Respiratory Questionnaire (SGRQ). We report the results of forty-nine patients.After surgery there was an improvement on functional and hemodynamic parameters and on QOL. The physical domain (PCS) of SF-36 was weakly but significantly associated with all functional parameters. There was no association between functional parameters and mental domain (MCS) of SF-36 or SGRQ. The improvement in 6-Minute Walk Distance was associated with an increase in MLHFQ.Both QOL and submaximal exercise tolerance improve after surgery. However only the physical domains of SF-36 appear to be significantly associated to the functional data.

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rain natriuretic peptide time course related to clinical outcome after pulmonary endarteriectomy

Andrea Maria D’Armini Giorgio Zanotti Matteo Pozzi Salvatore Nicolardi Corrado Tramontin

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Trattamento chirurgico del sarcoma primario dell’arteria polmonare

Bollettino della Società Medico Chirurgica di Pavia (2012)

Valentina Grazioli Marco Morsolini Gabriella Mattiucci G Orlandoni Andrea Maria D’Armini

Il sarcoma primario dell’arteria polmonare e un patologia estremamente rara. Dal 1923, anno della prima descrizione autoptica di questa patologia tumorale da parte del Doctor Moritz Mandelstamm [1], se ne riportano in letteratura circa 250 casi [2]. Si tratta di un gruppo di neoplasie altamente eterogeneo dal punto di vista anatomopatologico; il quadro clinico si puo presentare con manifestazioni comuni ai vari pazienti affetti; e essenziale tuttavia la diagnosi differenziale con il quadro di embolia polmonare piuttosto che di ipertensione polmonare cronica tromboembolica con le quali tale patologia neoplastica e piu comunemente confusa. A tal proposito e opportuno sospettare la patologia tumorale qualora si presentino peculiari manifestazioni cliniche al fine di diagnosticare il piu rapidamente possibile il sarcoma e pertanto valutarne l’approccio terapeutico adeguato. Nel nostro centro si e giunti, dopo anni di esperienza in merito, all’acquisizione delle seguenti due strategie terapeutiche: pneumonectomia come approccio di radicalita ed endoarteriectomia come approccio di palliazione, entrambe associate a chemio- e radio-terapia adiuvante.

10.6092/2039-1404.125.1040

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Pulmonary arterial compliance and exercise capacity after pulmonary endarterectomy

European Respiratory Journal (2014)

Stefano Ghio Marco Morsolini Angelo Guido Corsico Catherine Klersy Gabriella Mattiucci

Patients with chronic thromboembolic pulmonary hypertension (CTEPH), despite successful pulmonary endarterectomy (PEA), can continue to suffer from a limitation in exercise capacity. The objective of this study was to assess whether pulmonary arterial compliance is a predictor of exercise capacity after PEA. Right heart haemodynamics, treadmill incremental exercise test, spirometry, carbon monoxide transfer factor, arterial blood gas and echocardiographic examinations were retrospectively analysed in a population of CTEPH patients who underwent PEA at a single centre. Baseline and 3-month haemodynamic data were available in 296 patients; 5-year follow-up data were available in 68 patients. In a multivariable model the following parameters were found to be independent predictors of exercise capacity after surgery: age, sex, pulmonary arterial compliance, tricuspid annular plane excursion, arterial oxygen tension and carbon monoxide transfer factor (p<0.0001); the model showed good discrimination (Harrell's c=0.84) and calibration (shrinkage coefficient=0.91). Poor exercise capacity at 3 months was loosely associated with higher death rate during subsequent survival (Harrell's c=0.61). In conclusion, after successful PEA, reduced pulmonary arterial compliance is an important determinant of exercise capacity in association with the age and sex of the patients, and the extent of recovery of both cardiac and respiratory function. However, exercise capacity does not explain a large proportion of the effect of surgery on subsequent survival.

Endarterectomy

10.1183/09031936.00195313

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Citations (28)

[Surgical treatment of chronic thromboembolic pulmonary hypertension with pulmonary endarterectomy].

Giornale italiano di cardiologia (2006)

Andrea Maria D’Armini Giorgio Zanotti Matteo Pozzi Salvatore Nicolardi Corrado Tramontin

Acute pulmonary embolism is the third most common cardiovascular disease in Italy with approximately 65 000 new cases a year. Appropriate medical therapy does not necessarily prevent evolution of acute pulmonary embolism into chronic thromboembolic pulmonary hypertension (CTEPH), which occurs in 0.1-4.0% of cases. In our country, there are approximately up to 2600 new CTEPH patients a year. CTEPH is a progressive and potentially lethal disease. Medical therapy is palliative and only surgery can modify its natural history. Pulmonary endarterectomy (PEA) is the treatment of choice and lung transplantation should be considered only when PEA is contraindicated. Currently, nearly 4000 PEAs have been performed worldwide. Approximately ten centers are able to carry out this intervention with excellent and permanent results. Solid experience and close multidisciplinary collaboration allow appropriate patient selection, rigorous surgical technique, and adequate postoperative management. All these aspects represent the key to the success in the treatment of CTEPH. After PEA, quality and expected length of life are similar to the age-matched general population and the only therapy required is oral anticoagulation.

Endarterectomy

Medical Therapy

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