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Biomedical subjects

A Renzulli

Publications and source records attributed to A Renzulli.

At least 19 recordsLinked to original sources
PubMed1992

Acute thrombosis of prosthetic valves: a multivariate analysis of the risk factors for a lifethreatening event.

In 3231 prosthetic valves implanted between January 1975 and November 1990, we observed 61 cases of prosthetic obstruction of biological origin with clinical and laboratory findings of severe functional impairment which required surgery as emergency treatment. The hospital mortality was 19.67% (12/61). The obstruction was due to a primary thrombosis in all 5 bioprostheses which were not anticoagulated and in 11/56 (19.64%) mechanical prostheses of which 3 were not anticoagulated and 4 were not properly anticoagulated. The obstruction was due to fibrous tissue overgrowth in the other 45 mechanical prostheses (80.35%) with secondary thrombosis in 34 cases (60.71%) and no thrombosis in 11 (19.64%); 71.11% of these prostheses were adequately anticoagulated. Of the 61 obstructed prostheses, 53 were mitral and 8 were aortic. No tricuspid obstruction was observed. A statistical assessment by multiple correspondence, cluster and chi square analysis was performed in two groups of patients with different models of mechanical mitral prostheses. The 5-year actuarial incidence of obstruction was 6.08%. Significant risk factors were: tilting disc prostheses, prostheses without pyrocarbon coating, large prostheses, tilting disc prostheses with a small orifice posteriorly oriented, atrial fibrillation, enlarged left atrium, time from implant greater than 4 years, age between 40 and 50 years. In our opinion, prosthetic obstruction may be referred to a primary thrombosis only in cases where it may be prevented by adequate anticoagulation. In most cases, the obstruction is produced by periprosthetic fibroblastic proliferation which may develop in spite of adequate anticoagulation in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Dissection of the left main coronary artery: diagnosis by angioscopy.

A 58-year-old woman with mitral valve disease was investigated with cardiac catheterization. At catheterization, a suspected dissection of the left main coronary artery occurred. This diagnosis was confirmed at urgent operation by intraoperative angioscopy. The patient underwent mitral valve replacement and coronary artery bypass grafting and made a good postoperative recovery. Coronary angioscopy at operation provides a useful means of diagnosing pathology in the left main coronary artery.

Cineradiography↗
PubMed1990

Coronary artery spasm following coronary artery bypass grafting. Treatment with intracoronary ISDN followed by systemic intravenous nifedipine infusion.

Coronary artery spasm following coronary artery bypass grafting (CABG) has been described previously. The cause and underlying risk factors are mainly speculative and treatment therefore symptomatic. We present the successful management of this condition by administration of an intravenous Nifedipine infusion after intracoronary Isosorbide dinitrate (ISDN) had failed to relieve the spasm.

Angiography↗
PubMed1990

[Prosthetic valve endocarditis].

The Authors report their experience of the surgical treatment of cardiac prosthetic endocarditis. Between September 1974 and December 1988, 2,796 cardiac prostheses were implanted. An endocarditis in the follow-up of 23 patients involving 27 prostheses was diagnosed. The operative mortality was high in patients with mitral prosthetic endocarditis; in patients with infected aortic prosthesis operative mortality was low, but there was a high incidence of recurrence. The Authors emphasize the difficulty of diagnosis and the importance of the surgical treatment for eradication of the infection and for resolution of the haemodynamic defect.

Aortic Valve↗
PubMed1990

[Etiology and incidence of pure mitral insufficiency: a morphological study of 926 native valves].

From July 1981 to October 1988, 1597 native valves, 926 (58%) mitral and 671 (42%) aortic, were excised. The gross and histological features of all valves were studied using routine histochemical, immunohistochemical and electron microscopy techniques. As far as mitral valve is concerned the lesions were: stenosis 263 (28.6%), stenosis + incompetence 537 (57.8%) and incompetence 126 (13.6%). Our study was limited to the valves of patients undergoing mitral valve replacement because of pure incompetence. The pathological alterations of the valves were: floppy mitral valve (FMV) 59 (46.8%), rheumatic disease (RD) 50 (39.6%), infective endocarditis (IE) 13 (10.3%), papillary muscles ischemic disease (PMID) 4 (3.1%). In the FMV group the associated lesions were: aortic valve incompetence due to floppy aortic valve and noninflammatory aortic root disease (9-15.2%), tricuspid valve incompetence (4-7.8%) and atrial septal defect (7-13.7%). The commonest complication in this group was rupture of chordae tendineae requiring urgent surgery. In the RD group there was a high incidence of active rheumatism, valvulitis and papillary muscles myocarditis (37-74%) despite the laboratory data were within normal ranges. In the IE group there was an associated aortic endocarditis in 7 patients (53.8%). The FMV was the commonest cause of pure incompetence in patients who had mitral valve replacement. Rheumatic pure mitral incompetence was always associated in our experience to signs of active rheumatic disease.

Cohort Studies↗
PubMed1990

[Intermediate echocardiographic follow-up of a new model of pericardial prosthesis (Pericarbon)].

The paper deals with the echocardiographic medium-term follow-up of 11 patients fitted with a Sorin Pericarbon bioprosthesis. Four hundred and ninety-seven biological prostheses were implanted during the period January 1975 to December 1988, of which 22 (4.42%) were Pericarbon. The first 11 patients (mean age 55.3 years) who underwent isolated mitral or aortic valve replacement were included in the study. In 5 patients the bioprosthesis was implanted in mitral site, and in 6 in aortic. Post-operative 2D-Doppler echocardiographic tests revealed good hemodynamic performance indices, even in small calibre vessels, and the absence of early malfunctions. Although the number of patients studied is small, the absence of early malfunctions and the technical innovations of the bioprosthesis make it preferable to other pericardiac prostheses.

Adult↗
PubMed1989

Surgery for ventricular tachyarrhythmias based on fragmentation mapping in sinus rhythm alone.

Intraoperative arrhythmia activation mapping underlies the impressive success of surgery for sustained uniform ventricular tachycardia. Unstable arrhythmias and those intraoperatively noninducible, however, are not amenable to activation mapping and strategies for dealing with them are poorly defined. We propose that fragmentation mapping in sinus rhythm can be used to direct surgery in such situation. In 21 (33%) of 64 patients operated upon at this unit, intra-operative arrhythmia mapping was impossible because of non-inducibility in 17 (27%) and unstable morphology in 4 (6%). Endocardial resection was performed in all areas showing 'fragmented' local electrograms (greater than 100 ms duration at 30-300 Hz filtering). Mean patient characteristics included: age 51 years; LV ejection fraction 32%; major arrhythmic episodes 16 (range 2-200); antiarrhythmic drug failures, 4. There were 5 (24%) early postoperative deaths (heart failure 3; sudden 1; metabolic 1) and 1 early arrhythmia recurrence. There were 3 late non-arrhythmic deaths and 1 further arrhythmia recurrence during follow-up of 23 +/- 19 months. Both patients with documented postoperative arrhythmic episodes were controlled on previously ineffective antiarrhythmic drug therapy. Fragmentation mapping in sinus rhythm successfully extends the surgical option to arrhythmias previously considered inoperable. The results compare favourably with those for arrhythmias in which surgery was directed by activation mapping.

Adolescent↗
PubMed1988

Clinical results after cardiac valve replacement with the Sorin prosthesis. A 6-year experience.

The mechanical valve produced by Sorin is a modified tilting disc device. Between March 1979 and November 1985, 763 Sorin prostheses were implanted in 710 patients. The study has been restricted to 504 isolated mitral or aortic valves. There were 238 females and 266 males whose ages ranged from 2 to 71 years (mean 43.8). Follow-up is 99.23% and covers 1045 patient-years. No structural failure has been observed. In the aortic position, 282 Sorin prostheses were implanted with the large orifice orientated towards the right coronary sinus. Hospital mortality was 5% (14/282). Actuarial survival at 78 months was 94.68% +/- 1.6% with a linearized mortality rate of 1.7% patient-years. There were 11 late deaths (9 valve-related and 2 non valve-related). The linearized rate of occurrence of embolic events was 0.32 patient-years (2/268). Actuarial survival complication-free at 78 months was 90.88% +/- 2.83%. Preoperatively, 19.8% patients were in NYHA class II, 68.5% in III and 11.7% in IV; postoperatively, 79.3% patients were in NYHA class I, 19.5% in II and 1.2% in III. In the mitral position, 222 Sorin prostheses were implanted with the large orifice orientated anteriorly in 46 patients (group 1) and posteriorly-in 176 patients (group 2). Hospital mortality was 4.5% (10/222). Actuarial survival at 66 months was 93.25% +/- 2.1% with a linearized mortality rate of 2.8 patient-years. There were 12 late deaths (9 valve-related and 3 non valve-related). The 66-month actuarial freedom from embolic events was 95.8% +/- 1.89% with a linearized rate of occurrence of 1.44 patient-years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Cardiac valve replacement during pregnancy. Report of two cases.

Two successful cases of mitral valve replacement with cardiopulmonary by-pass and myocardial protection are reported. Postoperative anticoagulation was obtained with oral anticoagulants. The patients delivered two healthy newborns. The report suggests that an open-heart operation can be performed in pregnant women with an acceptable risk for the mother and the fetus.

Adolescent↗
PubMed1988

Clinical results after isolated aortic valve replacement with Sorin prosthesis: a 6-year experience.

The mechanical valve produced by Sorin is a modified tilting disc device. Over about a 6-year period, 763 Sorin Prostheses were implanted in 710 patients. No structural failure has been observed. 282 prostheses were implanted in aortic position with the large orifice oriented towards the right coronary sinus. Hospital mortality was 5% (14/282). Actuarial survival at 78 months was 94.68% +/- 1.6%, with a linearized mortality rate of 1.7% pt-years. There were 11 late deaths (9 valve related and 2 non valve-related). The linearized rate of occurrence of embolic events was 0.32 pt-years (2/268). Actuarial survival complication free at 78 months was 90.88% +/- 2.83%. Preop. 19.8% patients were in class II N.Y.H.A, 68.5% in III, 11.7% in IV; postop. 79.3% patients were in class I, 19.5% in II, 1.2% in III. The durability and satisfactory complication-free survival rate indicate the Sorin prosthesis as a fully reliable device for aortic valve replacement.

Adolescent↗
PubMed1987

Right intracavitary cardiac tumors. Surgical management.

The surgical treatment of 6 patients affected by right cardiac tumors is reported. Three of them showed a right atrial myxoma, 1 metastases from an occult embryonal carcinoma and 1 a leiomyosarcoma of the pulmonary artery. While clinical diagnosis was not reliable, the echocardiographic examination was able to assess the site of the tumor, supplying useful information for the anatomy and surgery in 5 cases out of 6; in one case, the diagnosis was reached intraoperatively. All the patients survived the surgical treatment: while those with atrial myxoma recovered completely, the others with malignant tumors died from metastases 5 to 10 months postoperatively. The importance of early diagnosis is stressed together with the role of surgery, which permits the recovery of cases with benign tumors and a longer survival of cases with malignant tumors.

Adult↗
PubMed1987

Results of reoperation for failure of cardiac bioprostheses.

A ten-year experience with reoperations for failure of cardiac bioprostheses is reported. 362 patients were operated for valve replacement with 412 bioprostheses. There were 35 (9.64%) reoperations for valve failure. Mean time between operation and reoperation was of 64.4 months. Operative mortality was 14.28%: 3 patients died for cardiac and 2 for extra-cardiac causes. Long-term mortality after reoperation was 6.25%. Morphological examination of the explanted bioprostheses confirmed the cause of bioprosthetic valve failure, due to calcific degeneration in 88.88% of case, to post-endocarditic rupture in 5.55% and to prosthetic thrombosis in 2.77%. The importance of timing reoperation is stressed in order to reduce the operative mortality. The conditions suitable for implantation of bioprostheses are listed.

Adolescent↗