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Biomedical subjects

A Frigiola

Publications and source records attributed to A Frigiola.

64 records · Page 4Linked to original sources
PubMedDate not supplied

[Current status of Senning's physiologic correction of transposition of the great vessels. Personal experience].

From January 1978 to December 1985, 70 children affected by TGA have been operated with the Senning operation. Among the 70 cases, 64 were simple TGA and 6 were TGA + VSD. The mean age at operation was 6 months (range 2 day - 3 years). Of 64 cases with simple TGA, two (respectively of 2 days and 40 days) died with an operative mortality rate of 3.1% of 6 cases with TGA and VSD, one died with a mortality rate of 16.6%. The total mortality was 4.2%. Since 1981 in a continuative series of 47 patients there were no deaths. Our current policy is now the following: after the diagnosis of simple TGA by ECHO, if the Rashkind septostomy is successful, we perform Senning operation over 3 months; if the Rashkind is unsuccessful, we give prostaglandin (PGE1) for a long period (25-30 days) and in case we do a Blalock-Hanlon septectomy. In conclusion we think that in our hands, the policy followed in the treatment of simple TGA is justified by the results achieved but this policy does not prevent us from using different techniques if the results are better.

Follow-Up Studies↗
PubMedDate not supplied

[Cardiosurgical intervention in extracorporeal circulation and intellectual performance in childhood. Study and follow-up of 20 cases].

6 and 12 months before and after surgery in E.C.C., twenty subjects, at the age of development between 6 and 14 years, suffering from congenital heart disease, were subjected to psychometric observations with tests of level and others (wisc, raven, pm 38, rey, bender), in order to analyse the intellective level, specific mental capacities and eventual modifications in the mental and cognitive performances of the patients. No psychometric, statistically meaningful variations were generally noticed during the 3 observations. No meaningful correlations resulted between the duration of E.C.C. and psychometric observations. The patients subjected to the E.C.C. longer than the average of the total group generally didn't show any statistically meaningful variations in the scores of the 3 observations. To sum up the authors think that the experimental group showed and maintained before and after the cardiac surgery, a normal developing and maturative level and anyway that after the follow-up, no changes in the several intellective capacities of the patient were noticed.

Adolescent↗
PubMedDate not supplied

[Deep hypothermia and cardiocirculatory arrest with the technic of central cooling in patients with simple transposition of the great arteries].

The deep hypothermia and cardiocirculatory arrest are employed mainly for two reasons; to reduce as much as possible the extra corporeal circulation time in patients more suitable to present the deleterious effects of the by-pass circulation, and to have surgical field completely free from the blood, making easier some surgical procedures. In the classic description of Hykasa the deep hypothermia necessary to have a safe cardiocirculatory arrest is obtained by means of surface cooling and an extracorporeal heat exchanger. In our experience deep hypothermia and cardiocirculatory arrest were achieved only by means of core cooling technique; 64 patients with TGA weighing less than 10 kg were operated upon by this method with a mortality rate of 3.1%. The most important mortality risk factors were associated to the low weight of the patients and to the age. The major criticism against core cooling is represented by the thought that this type of cooling can impair cerebral function. In 2 patients we had neurological complications but were unrelated to the technique. We conclude that, when is necessary to perform a cardiocirculatory arrest, the core cooling deep hypothermia is a good, simple and useful technique, with a low danger of neurological complications.

Extracorporeal Circulation↗
PubMedDate not supplied

[Portal hypertension and bleeding esophageal varices in children. Esophageal transection with paraesophagogastric devascularization versus shunting procedures (author's transl)].

It is known that portasystemic shunts in the treatment of portal hypertension causes in the long term a high rate of complications in children. The most severe are encephalopathy, postoperative hepatic failure in intrahepatic hypertension and occlusion or poor functioning of the shunts. The incidence of the last mentioned complication is high in children, especially in those operated in their early years of life. The most severe danger of portal hypertension is the haemorrhage from bleeding esophageal varices. During the last few years the technique of esophagogastric devascularization with esophageal transection and ligation of varices (Sugiura's procedure) has given a very high percentage of success in the long term. The Authors report their experience with Sugiura's procedure in 9 children with portal hypertension (average age at operation of four and half years). In six cases there was a prehepatic and in the other three an intrahepatic hypertension. The follow-up varied from six months to seven and half years with an average of almost four years. In all the children the surgical treatment was successful with the complete disappearance of haemorrhage and esophageal varices. For their own experience and for Sugiura's long-term results, the Authors think that Sugiura's procedure offers the most effective alternative to portasystemic shunts in the surgical treatment of portal hypertension, especially in early childhood.

Child↗
PubMedDate not supplied

[Trans-atrial correction of ventricular septal defects in infancy and childhood (author's transl)].

The Authors reviewed their surgical experience in correction of ventricular septal defects through tricuspid valve. 57 patients out of 59 operated for surgical closure of V.S.D. underwent this technique. All patients remained in sinus rhythm after surgical repair, 40% showed a right bundle block, and only in a case there was a right bundle block plus left anterior emiblock. Clinical conditions of all the patients greatly improved after intervention. Overall mortality in this series was 6.7%. The Authors conclude that trans-atrial approach is safe and advisable technique in surgical management of ventricular septal defects.

Bundle-Branch Block↗
PubMedDate not supplied

Renal effects of low dose aprotinin in pediatric cardiac surgery.

Two groups of 15 children aged from 15 days to 6 years, undergoing surgery on cardiopulmonary by-pass for congenital heart disease have been retrospectively analyzed. Group A received a low-dose aprotinin treatment (30,000 KIU/kg in the priming solution); group C (control group) did not receive any aprotinin. Groups were homogeneous for pathology, cardiopulmonary by-pass time, aortic cross-clamping time, cyanotic/acyanotic patients ratio, temperature during cardiopulmonary bypass. A number of postoperative data were measured: activated clotting time was without any difference between aprotinin-treated and control patients; the same went for temperatures, urine output, intubation time, stay in Intensive Care Unit, coagulation tests, platelet counts, hematocrit, survival rate, and blood loss. Serum creatinine levels were significantly higher in group A than in group C both at the arrival in Intensive Care Unit (0.81 +/- 0.27 vs 0.66 +/- 0.12, p = 0.032) and in the first postoperative day (1.01 +/- 0.5 vs 0.72 +/- 0.19, p = 0.038). BUN was significantly higher in group A vs group C in the first postoperative day (43.6 +/- 21.1 vs 33.9 +/- 16.7, p = 0.043). We conclude that low-dose aprotinin did not reduce postoperative bleeding; we cannot exclude that higher dosages could be more effective, but the evidence of a moderate tubular function impairment suggests caution in using high-dose aprotinin in children.

Aprotinin↗
PubMedDate not supplied

[The surgical treatment of fixed aortic subvalvular stenosis].

Over the past 5 years, 45 patients (11 adults and 33 children) have undergone operations for discrete and fixed subaortic stenosis. The resection of the subvalvular membrane or the fibromuscular collar was the procedure of choice. 28 patients underwent myectomy and/or myotomy. None patients died during operations. No significant symptoms and gradients remained after operation. We conclude that in the surgical management of fixed discrete subaortic stenosis myectomy and myotomy in addition to membranectomy produces better relief of the left ventricular outflow obstruction than do membranectomy alone.

Adolescent↗