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Biomedical subjects

C Valfré

Publications and source records attributed to C Valfré.

At least 19 recordsLinked to original sources
PubMed1994

Comparative diagnostic value of transesophageal echocardiography and retrograde aortography in the evaluation of thoracic aortic dissection.

The aim of this study was to assess the comparative diagnostic value of transesophageal echocardiography (TEE) and retrograde aortography for morphologic evaluation and anatomic mapping of aortic dissection. Seventy patients (aged 18 to 79 years) were prospectively evaluated with both techniques for suspected aortic dissection. In 64 patients, findings on aortography and TEE could be validated against intraoperative (n = 53) and postmortem (n = 11) findings. Examination time was significantly shorter for TEE (9 +/- 6 vs 48 +/- 25 minutes; p < 0.001). For the detection of aortic dissection, aortography showed lower sensitivity (87.5% vs 97.5%) and negative predictive value (85.3% vs 96.7%; both trends did not reach statistical significance) due mostly to the inability to identify noncommunicating dissection (dissection without intimal tears). For the epiphenomena of aortic dissection, aortography was significantly more accurate (97.2% vs 78%; p < 0.05) in assessing the site of entry, and TEE was more accurate in identifying thrombus formation (90% vs 65%; p < 0.05). There was no significant difference between aortography and TEE with regard to assessing secondary tears, aortic regurgitation, coronary dissection, and extension of the dissection. Thus, both TEE and aortography offer detailed anatomic mapping for guided surgical interventions. In elective patients, integration of both techniques seems the best approach; in unstable patients, TEE may be preferential because it is less invasive, requires no contrast injection, and provides accurate diagnosis in a short time at the bedside.

Adult↗
PubMed1994

Detection of acute thrombosis of mitral tilting disk prosthesis by transesophageal echocardiography.

Acute thrombosis is a very severe complication in the replacement of mechanical prostheses and most often fatal if immediate treatment is not implemented. We describe a case in which an acute thrombosis of a mitral tilting disk prosthesis was adequately diagnosed by transesophageal echocardiography and immediate surgical replacement of the dysfunctioning device was possible without catheterizing the patient.

Echocardiography, Transesophageal↗
PubMed1994

Seven-year experience with chordal replacement with expanded polytetrafluoroethylene in floppy mitral valve.

Among 106 patients operated on for implantation of artificial mitral chordae (expanded polytetrafluoroethylene), usually associated with other traditional procedures, 82 had degenerative valve disease. Two of them had the valve replaced during the same operation because of residual regurgitation, and one patient died (1.3%) of respiratory insufficiency. Seventy-nine patients left the hospital and were followed up to 84 months. No late deaths and only one valve-related complication were reported. This occurred in a patient who required reoperation after 18 months for sudden recurrence of mitral regurgitation caused by the rupture of natural chordae, which had been shortened during the first procedure, whereas the artificial chordae had retained their function. The clinical experience confirms positive experimental data, because this technique was reliable with lasting results. Application of artificial chordae, associated with other traditional techniques, is useful to improve the results and to extend the indications for mitral valve repair.

Adolescent↗
PubMed1990

Artificial mitral valve chordae: experimental and clinical experience.

Failure of mitral valve reconstructive procedures often may be ascribed to severe or progressive alterations of subvalvar apparatus. Expanded polytetrafluoroethylene sutures were used to replace anterior leaflet mitral valve chordae in 8 animals (hypertensive dogs and growing sheep). After the positive results obtained during a 13-month follow-up, 5-0 sutures of the same material were introduced in clinical practice to replace mitral valve chordae. Twelve patients had two to six anterior leaflet chordae replaced for degenerative or rheumatic disease. In 3 patients, the intraoperative result was not acceptable and a prosthetic valve was inserted during the same operation. One case of late failure has been recorded so far (18 months after the procedure), owing to rupture of a natural chorda shortened at operation. Since that event, we have implanted supportive artificial chordae in case of diffuse alteration of natural chordae. The remaining patients show satisfactory hemodynamic results, and no valve-related events have been recognized up to 30 months after operation. We suggest use of 5-0 polytetrafluoroethylene sutures in replacing anterior leaflet chordae in degenerative, rheumatic, and congenital mitral valve diseases.

Adult↗
PubMed1987

Prospective evaluation of combined carotid and coronary surgery.

In order to evaluate the effectiveness of combined carotid and coronary surgery in reducing the incidence of neurological disturbances after coronary artery bypass grafting (CABG), 144 consecutive candidates for CABG (group I) were screened for carotid disease noninvasively with Doppler ultrasonography (duplex). Twenty-six (18%) were considered at risk for stroke because of a severe (above 50% diameter reduction) stenosis; 20 (4 symptomatic and 16 asymptomatic) underwent combined surgery. Forty-seven other patients (group II) underwent CABG surgery without previous Doppler investigation. Only three patients (1.5% of the survivors) developed transient neurological disturbances after surgery; two who had normal internal carotid arteries belonged to group I, and one to group II. None of the six patients at risk for stroke who underwent only CABG developed neurological symptoms. The incidence of intra- and postoperative cardiac complications of the group who had CABG only compared to that of the group with combined surgery. We conclude that, although safe, combined surgery is not to be performed systematically on candidates for CABG with a significant internal carotid artery stenosis.

Brain Ischemia↗
PubMed1986

The use of intraluminal prosthesis in the surgical management of aortic dissection.

The treatment of acute aortic dissection requires expeditions and reproducible operations aimed at avoiding rupture of the dissection or its antegrade or retrograde progression. In 12 type A and 11 type B dissections the aorta was repaired using an intraluminal prosthesis to reduce the risk of hemorrhage and its related complications. Overall mortality rates were 33% in type A and 36% in type B patients, similar to that observed in patients operated with other techniques, but the incidence of intraoperative bleeding was possibly reduced and the cross-clamping time was significantly shorter. This method of repair is a sound alternative to conventional anastomotic suturing, particularly in clinically compromised patients and in the hands of surgeons on call, who may lack the experience of dealing with a particularly fragile aortic wall.

Aged↗
PubMed1985

Results of reoperation for primary tissue failure of porcine bioprostheses.

Results of reoperation for primary tissue failure of porcine bioprostheses were evaluated in 574 patients discharged from the hospital from 1970 to 1981. A total of 413 had undergone isolated mitral valve replacement and 161 isolated aortic valve replacement. Through March, 1984, 88 patients (15%) had required reoperation: 59 had undergone mitral and 29, aortic valve replacement. Primary tissue failure was the main cause of bioprosthetic dysfunction; it occurred in 64 patients (46 mitral and 18 aortic) at a mean postoperative interval of 93 +/- 4 months (range 34 to 158). During the same period, 11 patients required reoperation for bioprosthetic endocarditis, 11 for paravalvular leak, and two for thrombosis. These patients are not included in this review. Reoperation for primary tissue failure was performed after a mean interval of 72 +/- 6 months (range 38 to 158) for patients with aortic bioprostheses and after 101 +/- 5 months (range 34 to 153) for those with mitral bioprostheses (p less than 0.05). Overall mortality at reoperation was 12.5%: 11% for the mitral group and 16% for the aortic group. In 62 patients (45 mitral and 17 aortic) primary tissue failure was caused by calcification of the cusps, associated with severe fibrous tissue overgrowth in seven. Bioprosthetic failure was caused by an intracuspal hematoma in one patient with mitral valve replacement and by lipid infiltration of the cusps in one patient with aortic valve replacement. Actuarial freedom from bioprosthetic primary tissue failure at 12 years is 61% +/- 5% for the mitral group and 69% +/- 7% for the aortic group. On the basis of our long-term follow-up of patients after mitral or aortic replacement with a porcine bioprosthesis, we conclude: primary tissue failure is the most frequent indication for reoperation in patients with a porcine bioprosthesis; calcification of the cusp tissue is the leading cause of primary tissue failure; reoperation for primary tissue failure may be a major concern, although mortality for elective cases is low; and the limited durability of porcine bioprostheses suggests their use be restricted to selected patients.

Animals↗
PubMed1984

Dehiscence of aortic valve prostheses: analysis of a ten-year experience.

Up to the end of 1982, reoperation for dehiscence of an aortic prosthesis was necessary in 5% of patients operated on for primary aortic valve replacement in the previous decade at the University of Padova Cardiac Surgery Center. This complication occurred early (median time to diagnosis 4 months) and was associated with an elevated 30-day operative mortality (27%, 70% CL 19-37%). This is probably (P = 0.09) related to preoperative heart failure. The follow-up of the traced surviving patients (92%) indicates a continuing poor prognosis with a 6-year survival rate of only 13.5% (70% CL 5.0-30%). All the events were cardiac related and directly or indirectly connected with the persistence or recurrence of dehiscence that was observed in 72% of the cases. In the face of these results, a retrospective study has been performed to identify, on the basis of the available data, the subsets of patients more prone to develop this complication. Our results suggest that a significant increased risk (P less than 0.001) can be identified in patients presenting with bacterial endocarditis (12.2% rate), in patients with concomitant aneurysm of the ascending aorta (10.9%) and in patients with degenerative regurgitation or severe calcifications of their native valve, with rates of 7.0 and 6.0 respectively. In these situations particular care is required to avoid undue stress on the annular tissue. We also suggest the use of buttressed interrupted sutures.

Adult↗
PubMed1984

Isolated mitral valve replacement with the Hancock bioprosthesis: a 13-year appraisal.

Four hundred seventy-six patients underwent isolated mitral valve replacement (MVR) with the glutaraldehyde-preserved porcine Hancock bioprosthesis from March, 1970, through December, 1981. There were 312 female and 164 male patients ranging in age at operation from 9 to 68 years (average, 53 years). Associated surgical procedures were performed in 35 patients. Hospital mortality was 13%, the main cause of death being low-output syndrome. The survivors were followed from 1.6 to 13.2 years (mean, 5.2 years). Cumulative duration of follow-up is 2,180 patient-years and is 97% complete. Overall late mortality is 3.1 +/- 0.3% per patient-year, and actuarial survival is 73.8 +/- 3.4% at 13 years. Embolic accidents occurred in 45 patients and were fatal in 13; the linearized incidence of postoperative systemic thromboemboli is 2.1 +/- 0.3% per patient-year. Reoperation was necessary in 49 patients: in 4 because of valve endocarditis, with 3 deaths; in 6 because of perivalvular leak, with no deaths; in 2 because of left atrial thrombosis; and in 37 because of valve dysfunction due to primary tissue failure, caused mainly by calcific degeneration of the tissue, with 5 operative deaths. Actuarial freedom from primary tissue failure is 58 +/- 6.6% at 13 years. Extended follow-up after MVR with the Hancock bioprosthesis confirms the satisfactory performance and low thrombogenicity of this device up to 13 years after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1984

Myosin changes in hypertrophied human atrial and ventricular myocardium. A correlated immunofluorescence and quantitative immunochemical study on serial cryosections.

Two antigenically distinct types of myosin heavy chain, referred to as alpha and beta, have been identified in autoptic and bioptic specimens of human heart using specific antimyosin antibodies. By immunofluorescence heavy chain alpha was present in all atrial myocytes and in a variable number of ventricular myocytes. Heavy chain beta was present in all ventricular myocytes and in a number of atrial myocytes. Ventricular hypertrophy in patients with aortic stenosis, systemic hypertension or tetralogy of Fallot was characterized by an almost complete absence of fibres reactive with anti-alpha. A striking decrease in alpha chain reactivity and a parallel increase in beta chain reactivity was apparent in the hypertrophied left atria of patients with mitral stenosis. To quantify these myosin changes a novel procedure was developed whereby myosin was extracted from single cryosections serial to those processed for immunofluorescence and the relative amount of alpha and beta heavy chain was determined by enzyme immunoassay. Heavy chain alpha was less than 5% in most normal ventricular specimens and disappeared completely under the effect of pressure overload. On the other hand heavy chain beta was generally undetectable in the left atrial myocardium but increased up to 90% in biopsies of hypertrophied atria.

Adult↗
PubMed1983

Mitral valve prosthesis dehiscence necessitating reoperation. An analysis of the risk factors involved.

Between January 1970 and December 1981, a total of 21 reoperations for periprosthetic leak were performed on 20 patients out of 999 with previously implanted prosthetic mitral valves. In most of them reoperations were performed within the first year, since the initial procedure and the leading indications were intractable congestive heart failure or infection of the mitral prosthesis. The mortality rate was 30% and was related to the preoperative cardiac functional status. The preoperative variables significantly related to an increased incidence of dehiscence of the mitral prosthesis necessitating reoperation were a degenerative disease (P = 0.016) or an infective endocarditis (P = 0.0006) of the native valve, both causing mitral regurgitation. Rheumatic disease, type of prosthesis, supra- or subannular insertion, age of the patient, and operative year, were not significant, neither were calcifications that are probably neutralized by the routine use of special surgical techniques. It is suggested that the use of techniques specifically designed to eliminate periprosthetic leak in patients affected by mitral regurgitation due to degenerative or infective disease of the native valve, might lead to a further reduction of reoperations for this complication.

Adolescent↗
PubMed1983

Experience with operation for total anomalous pulmonary venous connection in infancy.

Twenty patients presenting with total anomalous pulmonary venous connection (TAPVC) in infancy underwent cardiac repair. Four had associated major intracardiac anomalies (complex TAPVC) and 16 had isolated TAPVC. All patients with complex lesions died during or shortly after the operation; they all had pulmonary venous obstruction (PVO). The associated malformations were critical pulmonary stenosis (one case), multiple ventricular septal defects (VSDs) (one case), mitral atresia (one case), and asplenia syndrome with common atrioventricular valve, double-outlet right ventricle, and pulmonary stenosis (one case). Among the patients with isolated lesions there were two surgical deaths, both in infants less than 1 month of age, with severe PVO and subdiaphragmatic drainage. Statistical analysis of these data shows a strongly incremental risk of surgical death due to the presence of associated malformations. Analysis of just isolated TAPVC shows a possible incremental effect due to neonatal age (less than 1 month) and PVO, these two factors being not clearly separated. There have been no late deaths and no late complications among the 14 survivors followed from 7 months to 10 years (mean 44 months). An aggressive surgical approach regardless of the age, degree of pulmonary hypertension, and type of anatomic connection is advised for isolated TAPVC. Some caution is recommended for complex TAPVC, in which a much higher risk is anticipated, particularly when a palliative pulmonary vein-to-left atrium anastomosis is performed.

Evaluation Studies as Topic↗