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Biomedical subjects

E Fedriga

Publications and source records attributed to E Fedriga.

18 recordsLinked to original sources
PubMed1997

Use of the retrograde "pull-through" technique.

A 50-year-old man, who 9 months earlier had undergone emergency operation for acute type I aortic dissection, was readmitted to our hospital with the diagnosis of an enlarging aneurysm of the false lumen involving the transverse arch and the proximal third of the descending thoracic aorta, due principally to redissection at the distal suture line of the ascending aortic graft. Replacement of the aortic arch and proximal descending thoracic aorta was performed by using the retrograde "pull-through" technique with hypothermic circulatory arrest and retrograde cerebral perfusion. Although circulatory arrest lasted 110 minutes, the patient was extubated on the 2nd postoperative day and had no central or peripheral neurologic damage. Mild, transitory renal dysfunction was observed in the 1st postoperative week, and the patient was discharged on the 18th postoperative day. He is asymtomatic at 15 postoperative months. Deep hypothermia and retrograde cerebral perfusion proved effective despite prolonged circulatory arrest. The retrograde "pull-through" technique is an effective method of replacing the entire thoracic aorta and should probably be considered for single-stage repair of acute type I aortic dissection with multiple intimal tears.

Acute Disease↗
PubMed1996

[Traumatic rupture of thoracic aorta: review of a 10-year experience].

We retrospectively reviewed the diagnostic imaging examinations of 22 patients affected with traumatic rupture of the thoracic aorta acquired in a 10-year period. Our study was aimed at investigating if the diagnostic approach to these patients has changed in the last 10 years, especially relative to the extensive use of Computed Tomography (CT). All the patients in our series were submitted to chest radiography and aortography; only 15 of them were submitted also to CT. Plain radiography showed enlarged mediastinum and altered aortic profiles in 22/22 patients, rightward deviation of the trachea and nasogastric tube with downward displacement of the left mainstem bronchus and apical cap in 7/22 patients and associated pleuropulmonary injuries in 11 patients. CT image quality was poor because of artifacts in 5 patients, while it demonstrated mediastinal hematoma in 10 patients and associated aortic outline alterations in 5 patients. Aortography always showed the site and number of aortic ruptures. In our experience, aortography should be performed next if chest radiography suggests mediastinal hematoma. CT should be performed before aortography if chest radiography demonstrates no mediastinal hematoma but is not convincingly normal and the patient needs CT studies for associated head and/or abdomen injuries. In this case, if CT is technically correct and its results are normal, aortography needs not be performed, whereas if CT findings are abnormal or not convincingly normal, aortography is mandatory. In the future, the approach to aortic trauma could be modified by transesophageal echocardiography, Magnetic Resonance Imaging and spiral CT, but the results of these imaging methods must still be validated with further extensive studies.

Adolescent↗
PubMed1996

[Diagnostic imaging of aortic pseudoaneurysm: study of 4 clinical cases].

Aortic pseudoaneurysm starts as small disruption of the aortic wall with an extravasation of blood into the mediastinum, contained only by fibrous tissue and by parietal pericardium. The most common cause of this condition is dehiscence or inflammatory processes of suture stitches after surgical interventions on aortic value or ascending sorts. Pseudoaneurysm represents about 40% of complications of cardiac surgery involving the ascending sorts. This complication occurs in about 1% of cases of aortic valve or ascending tract replacement. In this study, we evaluated, with different diagnostic techniques, 4 patients (all males, mean age 48 +/- 23 years, range 17-74) affected by aortic pseudoaneurysm occurring at different times after surgical intervention on the sorts. Clinically only 1 of the 4 patients referred chest pain. Repeated chest radiography and cardiac magnetic resonance were performed in every patient; 3 subjects were evaluated by transthoracic and transesophageal echocardiography; contrast-enhanced computed tomography was performed in 1 patients. Pseudoaneurysm diagnosis obtained by non invasive methods was later confirmed and better described by angiography. Our study demonstrated that transesophageal echocardiography and magnetic resonance are useful and reliable methods in the diagnosis of aortic pseudoaneurysm. However, in case of mediastinal he or pericardial effusion (suggestive of aortic pseudoaneurysm) by transesophageal echocardiography or magnetic resonance, angiography is necessary and may show the exact rupture site on the aortic wall. This diagnostic approach yields enough information for both diagnosis and surgical correction of this rare but high-risk pathological condition.

Adolescent↗
PubMed1995

[Magnetic resonance imaging in assessing the complications of cardiac surgery involving the ascending aorta].

Complications involving the ascending aorta after cardiac surgery are rare (< 1%). Clinical findings are aspecific and may present a long time after surgery. Diagnostic imaging is used to show the type of complication and to provide adequate information for a suitable therapy. The authors investigated both efficacy and usefulness of MRI in the study of cardiac surgery complications involving the ascending aorta. Ten patients treated for heart disease were examined with MRI. Eight of them had had aortic valve replacement, 1 ascending aorta replacement and 1 both. Chest radiography and MRI were performed in every patient; 4 patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), 2 patients TTE and 1 TEE; 2 patients were submitted to CT and 4 to angiography. MRI showed 3 ascending aorta aneurysms, 3 dissecting aneurysms and 4 pseudoaneurysms. In the patients with aneurysms and dissecting aneurysms, MRI correctly demonstrated both the aneurysm and the intimal flap. MRI showed only large pseudoaneurysms, depicting mediastinal hemorrhage suggestive of pseudoaneurysm if the latter was small. In such cases, only angiography showed the breach site. In conclusion, MRI can be considered the method of choice to depict cardiac surgery complications involving the ascending aorta if aneurysms and dissecting aneurysms are present, because it yields enough information for both diagnosis and surgery. In contrast, in pseudoaneurysms or mediastinal hematomas angiography is necessary to show the exact rupture site of the aortic wall.

Adolescent↗
PubMed1994

[Magnetic resonance in postoperative evaluation of aortic dissection].

The value of MRI was investigated in the demonstration of residual alterations and postoperative complications of aortic dissection. October 1988 to December 1992, fifty-nine patients were examined with MRI. The series consisted of 53 patients affected with type A and 6 with type B aortic dissection, all of them surgically treated. The following parameters were studied: 1) aortic dilatation above and 2) below the prosthesis, 3) redissection, 4) persistent intimal flap, 5) origin of abdominal vessels from the false lumen and 6) study of supra-aortic vessels. Twelve of 59 patients were considered normal since all parameters were negative. The aorta was dilated in 19 patients distal to the graft and in 4 proximal to it. Redissection was observed in 33 of 59 patients. Residual intimal flap was clearly demonstrated in 33 of 59 patients; the state of the false lumen was clearly depicted in 12 patients with SE images alone and in 18 of the extant 21 with phase imaging. In 11 of 59 patients abdominal vessels originated from the false lumen. In 53 of 59 patients supra-aortic vessels were clearly demonstrated and appeared to be involved in 10 patients. In 6 cases MRI failed to yield enough information. In our experience MRI is the method of choice for monitoring the aorta after surgical dissection to detect changes and complications and therefore choose the most appropriate treatment.

Adult↗
PubMed1992

[Fatal aortic dissection in a young woman at the 32nd week of pregnancy].

Aortic dissection in young women without Marfan disease is unusual. When it occurs it is often related to pregnancy. We report a fatal case of aortic dissection in a 29-year-old woman at the end of her first pregnancy. A prompt diagnosis and surgical treatment usually permits the physician to save both mother and fetus. In this case the delay in the diagnosis was fatal for both. We retain that knowledge of this rare complication of pregnancy is useful in order to refer patients early for surgical treatment.

Adult↗
PubMed1992

Successful resection of a tuberculous pseudoaneurysm of the descending thoracic aorta: case report and review of the literature.

An aneurysm of the descending thoracic aorta was found in a 55-year-old woman. She had hemoptysis, fever, and weight loss beginning 1 month before hospitalization. A miliary tuberculosis developed after angiography. The patient underwent surgical resection of the aneurysm, which proved to be tuberculous. The aortic wall was reconstructed with a Dacron patch. Antituberculosis pharmacotherapy, started before operation, was discontinued after 16 months of administration. The patient is doing well 19 months after operation. The English literature reports only 7 other cases of surgical treatment of tuberculous aneurysm of the thoracic aorta. According to previous reports, early surgical intervention, combined with preoperative and prolonged postoperative antituberculosis therapy and close postoperative follow-up, is mandatory in this group of patients.

Journal Article↗
PubMed1991

Aneurysm of an aberrant right subclavian artery. Report of a surgically treated case.

A 53-year-old man was admitted for treatment of an aberrant right subclavian artery aneurysm that had been diagnosed 5 years earlier and had recently begun to enlarge. The aneurysm, which involved the right subclavian artery from its origin, measured 47 mm in diameter and about 10 cm in length. Because of the lesion's size and friability, a 2-stage operation was performed. In the 1st stage, the right subclavian and right vertebral arteries were revascularized with double bypass grafts via a right cervical approach. In the 2nd stage, the patient was repositioned and a left thoracotomy incision was made. With the aid of left-heart bypass, the aorta was cross-clamped proximal and distal to the lesion, and the aneurysmal orifice was closed with a Dacron patch. The patient was discharged from the hospital on the 17th postoperative day and remains asymptomatic 24 months later. We recommend the 2-stage technique for similar cases because it prevents limb ischemia and reduces the risk of hemorrhagic and embolic complications.

Journal Article↗
PubMed1986

[Bronchial embolization in the prevention of hemoptysis caused by cystic fibrosis].

Bronchial arteries embolization is a routine treatment of hemophtysis. In patients affected by cystic fibrosis hemophtysis is often very serious, dangerous for their life. The extent of pulmonary lesions, the frequent bilaterality and respiratory dysfunction are contraindications to operation. The authors report their experience on three patients affected by cystic fibrosis with hemophtysis, in which bronchial embolization has been the only therapeutic choice. It performed a good result with immediate stopping of hemophtysis. In all three cases results were not serious relapses, but only rare slight hemophtysis.

Adolescent↗
PubMedDate not supplied

Acute posttraumatic rupture of the thoracic aorta: the role of angiography in a 7-year review.

Between 1983 and 1989, 15 patients with acute rupture of the thoracic aorta by blunt trauma were seen. Superior mediastinal widening and obscuration of the aortic arch were the most important findings on chest radiograph. Computed tomography examinations in 7 patients showed mediastinal hematomas but did not reveal aortic lesions. Definitive diagnosis of traumatic aortic rupture was established by aortography in all 15 patients. Intraarterial digital subtraction angiography proved to be as accurate as conventional film aortography and saved time.

Accidents, Traffic↗
PubMedDate not supplied

Transesophageal echocardiography in the evaluation of mediastinal masses.

To assess the diagnostic impact of transesophageal echocardiography in the evaluation of mediastinal masses, 30 patients with mediastinal abnormalities detected by routine chest roentgenogram underwent transthoracic and transesophageal echocardiography. Subsequently, 29 of the patients underwent computed tomography and 16 underwent magnetic resonance imaging. The location and structure of the masses as well as their relationship to the surrounding structures were assessed. Anatomic confirmation and histopathologic diagnosis of the mediastinal masses by surgical resection and biopsy was available for all patients. Transesophageal echocardiography was more accurate than transthoracic echocardiography in detecting mediastinal masses (90% versus 73%), in identifying their structure (100% versus 90%), and in evaluating their relationship to contiguous organs (89% versus 81%). No complication was observed during the examinations. Computed tomography correctly diagnosed the location, structure, and relationships in all patients but one; magnetic resonance imaging correctly evaluated the mediastinal masses in all 16 patients. Our study suggests that transesophageal echocardiography is a valuable and safe complementary method of evaluating mediastinal masses. Moreover, this technique allows the obstruction of vessels and heart cavities, valve regurgitation, and right and left ventricular function to be easily assessed.

Adult↗
PubMedDate not supplied

Postoperative MR follow-up of type A aortic dissection.

OBJECTIVE: We set out to study the efficacy of MRI in the demonstration of residual alterations and postsurgical complications of type A aortic dissection. MATERIALS AND METHODS: From October 1988 to December 1990, 28 patients, 18 patients with type I and 10 with type II aortic dissection, underwent MR examinations for postsurgical evaluation. Features evaluated included caliber of the aorta (a) above and (b) below the prosthesis; (c) redissection; (d) persistent intimal flap; (e) presence of abdominal vessels arising from the false lumen; and (f) status of thoracic supraaortic vessels. RESULTS: Five of 28 patients were considered "normal," due to negative results of the assessed parameters. Dilatation of the aorta was found distal to the graft in seven patients and proximal to the graft in two. Redissection was observed in 2 of 28 patients. Residual intimal flap was seen in 15 of 28 patients; the state of false lumen was well identified in 5 patients using only SE images and in 7 of the remaining 10 using phase imaging. In 25 of 28 patients, supraaortic vessels were well evaluated with involvement seen in 2 cases. In the three other patients, adequate identification was not possible. CONCLUSION: We believe MRI is the technique of choice for monitoring the aorta after surgery in aortic dissection to identify alterations and complications and institute suitable therapy.

Aortic Dissection↗