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Biomedical subjects

Alessandro Frigiola

Publications and source records attributed to Alessandro Frigiola.

24 records · Page 2Linked to original sources
PubMed2003

Moderate ischemic mitral regurgitation and coronary artery bypass surgery: effect of mitral repair on clinical outcome.

BACKGROUND AND AIM OF THE STUDY: The optimal management of moderate (grade 2-3+) ischemic mitral regurgitation (MR) at the time of coronary artery bypass grafting (CABG) remains the subject of controversy. The study aim was to determine whether mitral repair associated with CABG is preferable to CABG alone in patients with moderate ischemic MR, in terms of intermediate outcome. METHODS: Among 60 patients with moderate ischemic MR, 30 who underwent CABG plus mitral repair were compared with 30 others who underwent CABG alone. All patients underwent follow up echocardiographic and clinical examinations between 12 and 36 months after surgery. The decision to repair the valve during surgery was totally at the surgeons' discretion. RESULTS: Preoperatively, both groups were substantially homogeneous. Patients who had CABG plus mitral repair had a lower NYHA functional class at intermediate follow up, and fewer signs and symptoms of heart failure. On multivariate analysis, mitral repair proved to be a protective factor for the development of heart failure. The preoperative size of the mitral annulus was seen to be a risk factor for subsequent heart failure events. At intermediate follow up, echocardiographic parameters were significantly better in the mitral repair group (left ventricular volume smaller, ejection fraction and pulmonary artery pressure improved). CONCLUSION: The results of this case-control study showed that, in a homogeneous series of patients with moderate ischemic MR, repair of the mitral valve at the time of CABG leads to a better clinical status due to an improved hemodynamic profile.

Aged↗
PubMed2003

Infective endocarditis due to Capnocytophaga canimorsus.

We report the case of a 41-year-old woman with severe mitral regurgitation due to infective endocarditis caused by a rare zoonotic microorganism (Capnocytophaga canimorsus). She had had a rheumatic mitral endocarditis successfully treated with antibiotics when she was 13 years old. She arrived to our attention for a fever of unknown origin. She had been bitten by her dog and medicated the wound herself. About 2 weeks later she developed a fever with values up to 39.5 degrees C. Blood cultures were initially negative but in view of her particular history (dog bite), the samples were sent to a specialized center where a Capnocytophaga canimorsus (a commensal bacterium contained in the saliva of dogs and cats) infection sensitive to ceftriaxone was detected. The antibiotic therapy was consequently modified and the patient's fever resolved. At echocardiography a mild mitral stenosis with severe regurgitation (3-4+/4+) was detected. We planned surgical mitral repair but the operative findings clearly showed the need for mitral replacement and a 29 mm size bileaflet mechanical prosthesis was implanted. The postoperative course was regular and the patient was discharged on the fifth day. We highlight the importance of a careful history and correct work-up for the diagnosis and treatment of false negative blood culture endocarditis.

Adult↗
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↗
PubMed2002

The antithrombin III-saving effect of reduced systemic heparinization and heparin-coated circuits.

OBJECTIVE: To investigate the perioperative changes of antithrombin III (AT-III) activity using reduced systemic heparinization and the possible role of AT-III in determining a better postoperative outcome. DESIGN: Prospective randomized study. SETTING: University hospital. PARTICIPANTS: Patients undergoing elective coronary revascularization with cardiopulmonary bypass (n = 90). INTERVENTIONS: Of patients, 30 were treated with heparin-coated circuits and reduced systemic heparinization; 30, with heparin-coated circuits and full systemic heparinization; 30, with conventional circuits and full systemic heparinization. MEASUREMENTS AND MAIN RESULTS: Heparin-coated circuits with full systemic heparinization did not exert any effect on coagulation parameters. Low systemic heparinization resulted in a significantly (p < 0.01) higher hematocrit value on arrival in the intensive care unit and in significantly higher values of AT-III activity during cardiopulmonary bypass (66 +/- 12% v 57.4 +/- 13% and 59.1 +/- 12% in the full systemic heparinization groups; p < 0.05), on arrival in the intensive care unit (69.7 +/- 13% v 60.7 +/- 13% and 60.8 +/- 11% in the full systemic heparinization groups; p < 0.01), and on the first postoperative day (81.3 +/- 15% v 67.4 +/- 13% and 70.2 +/- 12% in the full systemic heparinization groups; p < 0.01). No differences were observed in the clinical outcome. CONCLUSION: Reducing systemic heparinization determines an AT-III-saving effect that could be responsible for the decrease in thromboembolic complications already observed by other authors. It induces higher hematocrit levels immediately after the operation, probably reducing the unmeasurable intraoperative blood loss.

Anticoagulants↗
PubMed2002

Arterial switch operation after multiple-stage left ventricular retraining.

Right ventricular dysfunction and tricuspid valve incompetence after atrial repair for transposition of the great arteries is an increasingly frequent problem. Left ventricular retraining to convert an atrial switch to an arterial switch is a well-known surgical option but can require a multiple-stage surgical approach. We report our successful multiple-stage experience with a 5-year-old girl.

Child, Preschool↗