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Andrea Moneta

Publications and source records attributed to Andrea Moneta.

15 recordsLinked to original sources
PubMed2006

Coma might not preclude emergency operation in acute aortic dissection.

BACKGROUND: Syncope or new onset focal neurologic deficits are described in as many as one fifth of patients with acute aortic dissection referred for surgery. Coma or stroke caused by involvement of the arch vessels and secondary brain malperfusion is considered a major contraindication for emergency aortic repair. Initial experience with emergency operation in selected patients with acute type A aortic dissection complicated by coma is described. METHODS: Five comatose (median Glasgow coma score, 5.5), hemodynamically stable (systolic blood pressure > or = 100 mm Hg) patients with preserved pupillary reactivity and coma duration of less than 12 hours underwent emergency surgical repair. The ascending aorta was always replaced using profound hypothermic circulatory arrest. RESULTS: There were no operative deaths. No hemorrhagic brain infarction developed postoperatively. Ischemic strokes were documented by radiology in 3 patients, and were always right-sided. Four patients returned to normal life with no neurologic sequelae, whereas 1 patient showed partially recovered left hemiparesis and mild cognitive impairment. CONCLUSIONS: Coma may not represent an absolute contraindication for resuscitative surgery in hemodynamically stable patients with acute type A aortic dissection. A larger experience is necessary to draw more definitive conclusions.

Acute Disease↗
PubMed2004

Posterior mitral valve restoration for ischemic regurgitation.

Chronic ischemic mitral regurgitation is traditionally a complex lesion to repair. Only restrictive annuloplasty has become an accepted strategy to avoid valve replacement, but results are unsatisfactory in some subgroups of patients. We describe an original technique that addresses the pathophysiologic mechanisms responsible for one of the most common subtypes of ischemic mitral regurgitation, ie, asymmetric tethering of the mitral leaflets after inferior myocardial infarction. The technique includes partial detachment of the posterior leaflet from the mitral annulus, annular plication, and posterior cusp plasty.

Chordae Tendineae↗
PubMed2003

An alternative technique for non-infective paraprosthetic leakage repair.

Severe paravalvular leak is generally a reason for the repetition of valve replacement surgery. On the contrary management of patients with mild and moderate defects is controversial. Long-term prognosis may be negatively affected if non-surgical strategy is adopted also in less symptomatic patients. The proposed technique of leak closure preserves the implanted prosthesis and may be useful in non-infective mild and moderate detachments. It may safely extend surgical treatment to less symptomatic patients suffering from this surgical complication.

Heart Valve Prosthesis↗
PubMed2003

Early surgical anteroseptal ventricular endocardial restoration after acute myocardial infarction. Pathophysiology and surgical considerations.

BACKGROUND: The efficacy and safety of surgical anteroseptal ventricular endocardial restoration (a procedure that excludes non-contracting scarred segments) in the left ventricle with chronic dilation and remodeling secondary to an anterior myocardial infarction are well established. We present a small series and discuss the indication for early left ventricular restoration in the setting of complicated acute myocardial infarction. METHODS: Early ventricular restoration was performed in 8 patients (4 males, 4 females, mean age 70 +/- 8 years). A postinfarction ventricular septal defect was diagnosed in 3 cases. All patients were operated, on an urgent or emergent basis, between 1 and 16 days following the onset of infarction. Surgical coronary revascularization was associated in 7 patients. RESULTS: There was one operative death. At discharge, echocardiographic morphofunctional assessment revealed: a reduction of the left ventricular end-diastolic and end-systolic volume indexes, an increase of the ejection fraction, and, most importantly, an improvement of remote myocardial shortening fraction. At a mean follow-up of 15.6 months (range 2-21 months), there were no late deaths and all survivors are in NYHA functional class I or II. CONCLUSIONS: Left ventricular restoration may represent an effective adjunct to the surgical management of patients with an acute extensive anterior myocardial infarction complicated by severe heart failure, with or without septal rupture.

Aged↗