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C Minale

Publications and source records attributed to C Minale.

At least 19 recordsLinked to original sources
PubMed1992

[Left atrial myxoma].

Left-atrial myxomas produce a broad array of clinical symptoms depending on their location, size, and morphology. The clinical presentation is characterized by obstruction of blood flow, systemic embolism, and unspecific systemic effects. Within 6 weeks, three patients presented in our clinic with left-atrial myxomas. Primary differential diagnoses were infective endocarditis, circulatory collapse, and transient ischemic attack of unknown origin. In all cases diagnosis was made with echocardiography (m-mode, 2D, TEE). In this review the etiology, epidemiology, and pathology are reported briefly. The variety of clinical symptoms with the corresponding differential diagnosis is presented systematically and discussed with our patients. Diagnostic, therapeutic, and prognostic aspects are summarized.

Adult↗
PubMed1992

[Superior vena cava syndrome after pacemaker implantation. Increased risk with DDD-systems? Case report].

Superior vena cava syndrome due to transvenous pacing leads is a rare event. Local infection as well as multiple leads are important predisposing factors. The case of a patient with superior caval syndrome after multiple complicated permanent pacemaker insertions is presented. Medical treatment was unsuccessful. At operation a fibrous narrowing of the vena cava superior was found. The two leads (DDD-pacemaker) were left in place. A Goretex patch was used for enlargement of the anterior wall of the vein. Postoperatively, the patient remained free of symptoms and the vein was patent angiographically. In case of failure of medical management surgical correction should be attempted without delay.

Blood Vessel Prosthesis↗
PubMed1991

Surgical correction of coarctation in early infancy: does surgical technique influence the result?

Between 1979 and 1988, a total of 53 infants less than 1 year of age underwent repair of coarctation. Thirty-seven patients (70%) were younger than 3 months. Median age was 0.9 month. Four different surgical techniques were used: resection with end-to-end anastomosis, patch enlargement, subclavian flap aortoplasty, and subclavian displacement aortoplasty (Meier-Mendonca technique). Hospital mortality was 7.5% and was limited to patients with additional complex intracardiac defects. Neither age nor surgical technique had an influence on the operative risk. Follow-up averaged 15 to 43 months for the four different groups. Restenosis developed in 9 (19%) of 47 patients regularly followed up, 5 (11%) of whom have had reoperation. Age at operation was not a predictor for restenosis, which occurred in 17.4% of patients less than 1 month and 20.8% of those greater than 1 month of age at operation. Patch enlargement and the subclavian displacement technique demonstrated the highest restenosis rates (42% and 43%, respectively). However, patients who underwent patch enlargement had less favorable pathological conditions. It is concluded that results of coarctation repair in early infancy do not depend as much on the operative method itself as on the specific pathological aspect, which largely determines the method of treatment. Some reservation must be made in regard to the subclavian displacement technique.

Anastomosis, Surgical↗
PubMed1990

New site for pacemaker generators in children.

Bipolar pacemaker implantation was performed in three children, aged 5, 6 and 9 years. The two epimyocardial fishhook pacing electrodes were inserted through different incisions. After resection of the anterior part of the 5th and 6th rib, the generator was placed into a pocket with the posterior wall resulting from the remaining periostium/perichondrium and the anterior wall consisting of the isolated intercostal and pectoral muscle. The leads were brought in extrapleurally and connected to the generator. The operations were conducted without perioperative and late postoperative complications.

Child↗
PubMed1990

Carpentier ring.

Explore the source record for details and available documents.

Heart Valve Prosthesis↗
PubMed1990

Selective annuloplasty of the tricuspid valve. Two-year experience.

Between July 1986 and March 1989, 48 patients whose ages averaged 60 +/- 6 years were subjected to a new technique for tricuspid valve annuloplasty. The preoperative New York Heart Association functional class averaged 3.7. There were 32 mitral-tricuspid procedures, 13 aortic-mitral-tricuspid procedures, and three repeat tricuspid annuloplasties. The hospital mortality rate was 6.3% with three deaths resulting from cardiac or respiratory failure, or both. Follow-up averaged 14 +/- 8 months. One patient (2.2%) died suddenly, 7 months postoperatively. All patients whose follow-up period lasted 6 months or more improved to class I or II. Twenty-six patients were reinvestigated by catheter or echocardiographic methods, or both. The gradient over the tricuspid valve averaged 1.4 +/- 0.6 mm Hg, and a moderate regurgitant murmur (2/3) was detected in four cases. The diameter of the tricuspidal anulus in the apical four-chamber view decreased from 23.7 +/- 3.9 mm/m2 body surface area preoperatively to 15.7 +/- 1.9 mm/m2 body surface area at late follow-up examination. The present technique allows an anatomic and functional reconstruction of the tricuspid valve with a good compromise between stenosis and regurgitation. The overall mortality rate is low and functional improvement is striking.

Adult↗
PubMed1989

Computed tomographic patterns of proven embolic brain infarctions.

To define patterns of infarction on computed tomography that are characteristic of embolism, as opposed to hemodynamically or microangiopathically induced brain lesions, a consecutive series of 60 patients with acute brain embolism were studied. Strokes were embolic in origin; that is, hemodynamic and in situ thrombotic stroke mechanisms had been excluded. Embolically active, cardiac disease was proved in 42 and was clinically evident in 13 patients. Five patients had suffered a stroke due to catheter-related embolism. Computed tomography revealed pial artery territorial infarction in 55 patients (92%). In 5, the infarction had the size or location (or both) characteristic of lacunes, although shape and lack of multiplicity raised questions about this interpretation. No patient showed a low-flow type of infarction pattern. These findings strongly support the view that (1) except for in situ thrombosis, pial artery territorial infarctions are indicative of an embolic mechanism, and (2) that the mechanism underlying lacunes is hardly, if ever, embolic.

Adolescent↗
PubMed1989

Long-term follow-up after Carpentier tricuspid valvuloplasty.

To study the long-term results of tricuspid valvuloplasty, pre- and postoperative (51 +/- 17 months) echocardiographic and catheterization data were collected from 51 patients (aged 59 +/- 9 years). Because of severe mitral stenosis all patients received a heterograft in the mitral position and underwent reconstructive tricuspid surgery with Carpentier rings. With regard to postoperative clinical outcome three patient groups were distinguished: 37 patients (group A) showed clear clinical improvement; in seven patients mild, and in three patients moderate tricuspid regurgitation persisted. A mild tricuspid stenosis of less than 4 mm Hg mean diastolic gradient was found in 11 patients. Patients in group B (n = 8) showed no clinical improvement, but there was persistence of moderate tricuspid regurgitation associated with nearly unchanged pulmonary hypertension in five patients and moderate tricuspid stenosis in two. Six patients (group C) showed deterioration of their clinical status; in two patients a severe degree of tricuspid regurgitation persisted, and four patients were first seen with a tricuspid stenosis with a mean diastolic gradient greater than 7 mm Hg. Analysis of postoperative data showed that tricuspid stenosis may develop during surgery in patients with slightly shrunken valve leaflets. Although the area of the anterior tricuspid leaflet was slightly underestimated, we found that long-term results of tricuspid valve annuloplasty with a Carpentier ring were encouraging. Doppler echocardiography for detection of tricuspid regurgitation and transvalvular pressure gradient showed results identical to hemodynamic data and is a suitable and sensitive method for evaluating postoperative results after tricuspid valve annuloplasty.

Aged↗
PubMed1989

Controversial aspects of coronary endarterectomy.

Between 1980 and 1987, 635 patients underwent coronary bypass grafting combined with coronary endarterectomy. A total of 728 vessels were endarterectomized and grafted. There were 15 early deaths (2.3%). The mortality rate was higher (7.8%) for multiple-vessel endarterectomy (p less than 0.05). The ratio of MB fraction of creatine kinase to total creatine kinase was greater than or equal to 0.10 in 48% of the cases. The first consecutive 132 survivors were followed for an average of 16 months (range, 4 months to 5 years). No late deaths occurred. Fifty-nine unselected patients underwent postoperative recatheterization at a mean interval of 18 months. An improvement in heart wall contractility could be detected in 13 patients (16.5%) and deterioration in 14 patients (17.7%). A more detailed analysis of wall contractility showed a higher rate of improvement in the posterior wall than in the anterior wall (p greater than 0.05). Furthermore, the better the contractility before operation, the greater the rate of deterioration after operation (p less than 0.05). Despite an average of 55% of all endarterectomized vessels being occluded or severely restenosed, 90% of the patients were clinically improved. A multiparametric analysis revealed that the revascularization of myocardial areas that required endarterectomy had no significant influence with respect to clinical improvement. Endarterectomy should be limited, whenever possible, to myocardial areas with already impaired contractility. Endarterectomy of multiple branches should be treated with caution because the risk of deterioration is potentiated, with a significantly higher perioperative mortality rate.

Adult↗
PubMed1989

Late results after intracoronary thrombolysis and early bypass grafting for acute myocardial infarction.

Successful thrombolysis for acute myocardial infarction reduces early mortality. For definite correction of the underlying arteriosclerotic lesion, invasive treatment is mandatory. Early bypass grafting has been performed in 70 patients with an ischemic interval of less than 4 hours before reperfusion by thrombolysis. Surgery was undertaken an average of 4.5 days after the streptokinase administration. The hospital mortality rate was 1.4%. At 8 years the actuarial survival rate was 88% and the complication-free survival rate, 84%. At the latest follow-up study, 90% of the patients were in functional class I or II. Because of advanced age, 37% of the survivors have retired and 29% are working. Thirty-four percent did not return to work after the operation. In 24 patients a transmural needle biopsy specimen was taken at operation to study the extent of ischemic damage. Surprisingly, the extent of necrosis did not correlate with the ischemic interval (r = 0.17), whereas enzyme activity and extent of necrosis did correlate (r = 0.76). Late angiography was done in 44 patients (56%). The correlation between ischemic interval and regional wall motion score was weak when the whole group was considered (r = 0.35), but 70% of the patients with an ischemic interval of less than 3 hours had normal or near normal regional wall motion. In patients with prolonged ischemia, distribution between normal function and severe damage was uniform. In patients with ultrastructural and wall motion studies, early necrosis and late left ventricular function correlated fairly well (r = 0.69). We conclude that additional early bypass grafting after successful thrombolysis yields excellent long-term clinical results, especially in patients with an ischemic interval of less than 3 hours.

Age Factors↗
PubMed1988

Clinical experience with expanded polytetrafluoroethylene Gore-Tex surgical membrane for pericardial closure: a study of 110 cases.

Complete closure of the pericardium after cardiac operations has the advantage of avoiding injury of the heart and great vessels during reoperation. Between 1985 and 1987, the pericardium was closed with Gore-Tex Surgical Membrane (SM) in a selected series of 110 patients 1 month to 76 years of age. Fifty-three patients had congenital heart lesions and 57 patients had acquired heart disease. Overall hospital mortality was 3/110 cases. In no instance was there a relationship between occurrence of death and pericardial closure with SM. There was one episode of cardiac tamponade on the seventh postoperative day. One patient developed fever and leukocytosis due to a mediastinal hematoma. During a mean follow-up of 15 months, four patients had to be reoperated upon three, four, eight weeks, and eight months after primary operation. The anterior wall of the heart had no adhesion with the SM and the other parts of pericardium could be dissected easily. Scanning electron microscopic examination of the explanted SM patches showed neither cellular ingrowth nor immunocompetent cellular elements. The Gore-Tex Surgical Membrane has the advantages of easy availability and lack of reaction between its surface and the epicardium and pericardium. We believe its routine use should be encouraged in patients with high probability of reoperation after repair of complex cardiac anomalies, implantation of bioprostheses, coronary revascularization for one- or two-vessel disease, and repair of degenerative disease of the ascending aorta.

Adolescent↗
PubMed1987

Closure of the pericardium using expanded polytetrafluoroethylene GORE-TEX-Surgical Membrane: clinical experience.

Complete closure of the pericardium after cardiac operation would have the advantage of avoiding injury of the heart and great vessels should repeat sternotomy prove to be necessary. In such situations, various pericardial closure techniques have been described. Synthetic materials produced severe scarring, while xenografts appeared to be satisfactory, although fibrous reactions and aseptic cystic formations have been reported recently. Between 1985 and 1986 we closed the pericardium with GORE-TEX-Surgical Membrane in a selected series of 72 patients aging 1 month to 76 years, median 24 years. Overall hospital mortality was 3/72 cases. In no instance was there a relationship between death occurrence and pericardial closure through Surgical Membrane. There were 5 cases each of low cardiac output and rethoracotomy because of bleeding. No cardiac tamponade occurred. Two patients had to be reoperated three and four weeks after primary repair. Surgical Membrane was explanted. Electron microscopy examination showed no cellular ingrowth in the low porosity membrane. No immunocompetent cellular compounds were present on either side of the graft. Follow-up interval averaged 13 months. No complication related to pericardial closure has occurred until now. The Surgical Membrane has the advantages of easy availability, of lack of reactions both between its surface and the underlying epicardium and with the rest of the pericardium. We believe its routine use should be encouraged mainly in patients with high probability of reoperation.

Adolescent↗
PubMed1987

New developments for reconstruction of the tricuspid valve.

Four patients with multivalvular disease underwent tricuspid valve repair by a new technique. The anterior and posterior leaflets adjacent to the incompetent commissure were separated from the anulus to allow coaptation of the three leaflets in the middle. In conjunction with the commissure, half of the isolated anulus was then excluded with a continuous 3-0 Ti-Cron suture. A 5-0 Prolene suture was then used to readapt the cut edges of the leaflets to the shortened anulus. In this way it was possible to reduce the circumference of the anulus selectively, without reducing the active area of the leaflets. All patients survived. A significant decrease in the mean right atrial pressure without evidence of regurgitation could be recorded in all patients. Postoperative morphometric echocardiographic evaluation of the tricuspid valve showed a maximal anulus diameter even larger than in normal hearts. No inflow obstruction was present. The systolic shortening of the anulus ranged within normal limits. The opening amplitude of the leaflet as well as the slope of the ejection fraction were not decreased. No significant regurgitation was evidenced by contrast echocardiograms. One to 3 months postoperatively, no annuloplasty dehiscence has occurred.

Aged↗