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Biomedical subjects

F Orzan

Publications and source records attributed to F Orzan.

At least 19 recordsLinked to original sources
PubMed1998

Early and late risk factors in surgical treatment of acute type A aortic dissection.

BACKGROUND: Morbidity and mortality of emergency repair of type A dissecting aneurysms of the aorta are high. This is an attempt to investigate the risk determinants of early and late results. METHODS: A series of preoperative and operative variables were retrospectively collected from the clinical records of 291 patients operated on between January 1, 1979, and December 31, 1995. Risk factors for surgical death were investigated with univariate analysis and stepwise logistic regression. Follow-up was conducted between December 1995 and February 1996. Analysis of late results was conducted by means of actuarial survival curves (life method). After removing the surgical deaths, risk factors for late deaths were analyzed by a Cox model. RESULTS: The in-hospital mortality rate was 36.1%. Significant independent determinants of operative or early death were preoperative shock, preoperative neurologic impairment, operation before 1986, perioperative bleeding, and prolonged clamping time. The 10-year survival rate was 36.9% +/- 4.4%. Twenty-six patients required repeat operation. The long-term prognosis was significantly worse in patients who needed reoperation. CONCLUSIONS: Growing awareness of this disease and quicker diagnosis have increased the number of patients with acute dissection of the ascending aorta who are taken early to operation. This new challenge must be met by better preoperative support and intraoperative monitoring, and by surgical techniques that focus on lowering the rate of late complications, for which lifelong follow-up must be provided.

Adult↗
PubMed1995

Complicated removal of a hydatid cyst of the interventricular septum.

In a 27-year-old woman with a large hydatid cyst of the liver, an asymptomatic cardiac cyst located in the interventricular septum was discovered as well. The diagnosis was based upon echocardiography, computerized axial tomography and nuclear magnetic resonance. There was no evidence of damage to the atrioventricular conduction system or to the cardiac valves. At operation, however, the left posterior papillary muscle and chordae were firmly adherent to the cyst. Patch closure of the resulting ventricular septal defect, and mitral valve and chordae repair were necessary. The patient is alive and well 6 months after the operation, with mild residual mitral regurgitation. Precise anatomical delineation of the hydatid cyst localization within the heart, particularly in the interventricular septum, and its relations with the various cardiac structures is a difficult task, in spite of all the imaging techniques available. The surgical approach therefore has to be very careful and mindful of the potential complications.

Adult↗
PubMed1995

[Hypertrophic obstructive cardiomyopathy in a patient with Turner syndrome].

A case of hypertrophic obstructive cardiomyopathy in a patient with Turner syndrome is reported. The most frequently associated cardiac anomalies are coarctation of the aorta and bicuspid aortic valve. Hypertrophic cardiomyopathy has never been reported in this syndrome but is frequent in Noonan syndrome. In these two conditions the phenotype may be indistinguishable but the cariotype is different: normal in Noonan and 45X in Turner syndrome. Our patient had the typical somatic features, and the cariotype was 45X in all examined cells. A familial form of hypertrophic cardiomyopathy was excluded by the normal clinical examination of other members of the family. The presence of hypertrophic cardiomyopathy also in Turner syndrome and the recent localization on the long arm of the chromosome 12 of the gene for Noonan syndrome might postulate a common pathogenesis of the two syndromes.

Cardiomyopathy, Hypertrophic↗
PubMed1994

[Percutaneous transluminal coronary angioplasty for postinfarction residual ischemia: mid- and long-term results].

Aim of this study was to assess the long-term results of PTCA in patients with a recent myocardial infarction. The study population consisted of 244 consecutive patients who underwent a PTCA < or = 30 days after myocardial infarction either because of angina (116 patients), or because of provoked ischemia (62 patients), or in the absence of both (66 patients). "Simple" balloon angioplasty, without adjunctive devices, was performed. Most of the patients were seen at 1 year intervals at the outpatient clinic; otherwise information was gathered either from the family physician or by telephone. The following events were noted during a follow-up of 6-102 months (median 39 months): death, myocardial infarction, need for re-PTCA or surgical revascularization, recurrence of angina. Survival and event-free curves were calculated according to the method of Kaplan and Meier; statistical comparisons between the curves were obtained by the log-rank test. Periprocedural deaths, infarctions and surgical revascularizations are included in the actuarial curves. Differences were examined between patients with Q and non-Q wave infarctions, single vessel versus multivessel disease, left ventricular ejection fraction > or 50% versus < 50%. A clinical success was achieved in 85% of the procedures. Sixteen patients were lost at follow-up. Overall, within the first 30 days and during follow-up, 12 (4.9%) patients died, 19 (7.7%) suffered from myocardial infarction, 34 (13.9%) required re-PTCA or surgical revascularization, and 63 (25.8%) experienced angina again.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

[Does coexistence of involvement of the right dominant coronary artery differentiate clinical features of disease of the common trunk from disease of 3 coronary vessels?].

We have studied clinical and ECG stress features of 119 patients with left main disease and 113 matched patients with three vessels coronary disease. Clinical features and ECG stress test do not differentiate the two groups as a whole. Exercise time duration was shorter, ST criteria were more positive, and peak heart rate was lower in the subgroups of patients with left main and involvement of a right dominant coronary artery. However due to a large overlap these criteria do not seem to be clinically useful. In conclusion, in an individual patient angina and stress ECG criteria do not differentiate the patients with left main from those with three vessels coronary artery disease.

Angina Pectoris↗
PubMed1994

[Radiation-induced constrictive pericarditis. Associated cardiac lesions, therapy and follow-up].

OBJECTIVES: To evaluate the diagnostic and therapeutic problems that occur in managing patients with radiation-induced constrictive pericarditis. BACKGROUND: Radiation therapy of the chest and mediastinum can damage all cardiac structures, the pericardium being the most frequently involved one. It is little appreciated, however, that radiation-induced constrictive pericarditis can be associated with significant involvement of coronary arteries, myocardium and valves. METHODS: Retrospective evaluation of clinical, hemodynamic, surgical and postoperative data in 8 patients, (7 women, 1 man, aged 26-67 years, mean 44), who had received 30-50 Gy to the chest because of Hodgkin's disease, lymphoma, or breast cancer 7-23 years before the diagnosis of constrictive pericarditis. RESULTS: Six patients had symptoms related to the pericardial disease, one had angina and syncope, one was in congestive heart failure. Hemodynamic signs of constriction were obvious in 6, and were revealed by volume load in 2. All patients had mitral regurgitation, 5 had also tricuspid insufficiency and 5 had aortic regurgitation. The degree of the valvular regurgitation was > or = 3+ in four instances. Critical coronary arterial stenoses were discovered in 3 cases. The coronary ostia were involved in 5 cases (2 critical, 3 non critical). A diagnosis of restrictive cardiomyopathy was arrived at in 4 instances, always after pericardiectomy. Seven patients were operated on: there were 6 pericardiectomies, associated with either valvular surgery or myocardial revascularization or both in 3. One patient underwent myocardial revascularization only. The remaining patient is being treated medically. One patient died at surgery, two died 16 and 72 months thereafter. The remaining 5 have mild symptoms 11-60 months (mean 29) after the discharge from the hospital. CONCLUSIONS: Radiation-induced pericardial constriction is frequently associated with coronary artery disease, mostly silent, with valvular insufficiency, and with myocardial disease. Thorough cardiac evaluation in such patients is mandatory. Surgical treatment frequently uncovers an underlying restrictive myopathy that presents a serious diagnostic and therapeutic challenge.

Adult↗
PubMed1994

[Do our patients follow the clinical indications prescribed after coronary angiography?].

BACKGROUND: Aim of the study is to evaluate patients compliance with therapeutic recommendations after coronary angiography. METHODS: We analyzed all patients who underwent coronary angiography in an university center during 1990. One of the following treatments were recommended: medical therapy without revascularization, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting. A cohort of 392 patients was assessed one year after coronary angiography in order to evaluate clinical predictors of non compliance with the treatment recommended. RESULTS: Of the 141 patients, for whom medical treatment was recommended, 16 (11%: 95% confidence interval 6-17%) had revascularization. By stepwise discriminant regression analysis, older age, congestive heart failure and critical lesion of the left anterior descending artery were statistically significant predictors of non compliance. Of the 137 patients, for whom PTCA was recommended, 8 (6%: 2-9%) were non compliant. No variables were predictive of non compliance. Of the 114 patients, for whom CABG was recommended, 15 (13%: 7-19%) were non compliant. By stepwise regression analysis, absence of typical angina was predictive of non compliance. For 12 patients non compliance was related to personal preferences, for 10 to clinical deterioration, for 9 to a second opinion, and 3 were still in the surgical waiting list one year after coronary angiography. One year mortality was not affected by non compliance. CONCLUSIONS: Non compliance to recommended treatment after coronary angiography is uncommon and is mainly related to patients preference towards a less invasive treatment or to a change of clinical conditions over time.

Aged↗
PubMed1994

[Angiographic criteria in the diagnosis of hypertrophic cardiomyopathy].

AIM: To evaluate the commonly adopted ventriculographic and coronarographic criteria of hypertrophic cardiomyopathy. POPULATION: Eleven cases of obstructive cardiomyopathy, 14 non-obstructive cardiomyopathies, 15 discrete subaortic stenoses, 10 valvular aortic stenoses, and 12 cases of hypertensive heart disease. The diagnosis had been arrived at by independent clinical, electrocardiographic, echocardiographic and haemodynamic methods, as appropriate. METHODS: Retrospective "blind" examination of biplane left ventriculography (30 degrees right anterior oblique, 60 degrees left anterior oblique, with cranial tilt) and coronary arteriography. We looked for the following features: subaortic chamber, asymmetric septal hypertrophy, peculiar left ventricular shape and systolic obliteration, systolic anterior movement of the mitral leaflets, systolic narrowing or compression of epicardial coronary arteries and septal perforators. RESULTS AND CONCLUSIONS: The following left ventricular features were significantly more frequent in hypertrophic obstructive cardiomyopathy, than in other forms: subaortic chamber, "banana" configuration in systole, subaortic conus, asymmetric hypertrophy, systolic anterior movement of the anterior leaflet of the mitral valve, and mitral regurgitation. A subaortic chamber was seen both in the obstructive form and in the discrete subaortic stenosis, but the cranial left anterior oblique projection could easily discriminate between them. If non-obstructive cardiomyopathy is defined with the current criteria (provocable pressure gradient of < or = 30 mm Hg in a patient with left ventricular hypertrophy of no known cause), no distinctive angiographic features can distinguish it from other forms of secondary left ventricular hypertrophy.

Angiography↗
PubMed1993

Associated cardiac lesions in patients with radiation-induced complete heart block.

We investigated the clinical, electrophysiological, haemodynamic and angiographic aspects of four patients (two men and two women, aged 31-46 years) who developed complete heart block 13-20 years after therapeutic irradiation of the chest for Hodgkin's disease. The initial cardiac symptom was syncope in three, effort intolerance in one. The electrocardiogram recorded third-degree atrioventricular block in three patients, right bundle branch block and posterior fascicular block in one. The electrophysiological study, performed in three cases, showed that the block was infranodal in two. Three patients had significant coronary arterial stenoses, that involved the ostia in two. All patients had mild-to-moderate aortic and mitral regurgitation. One patient had haemodynamic signs of constriction. Another patient had recurrent pericardial effusions. All had echocardiographic evidence of a thickened pericardium. Cardiac involvement can be extensive in patient with radiation-induced heart block. Because coronary artery disease can be particularly severe, coronary angiography appears to be warranted in such patients.

Adult↗
PubMed1993

Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment.

OBJECTIVE: To define the clinical and angiographic features and the therapeutic problems in patients with coronary artery disease after therapeutic irradiation of the chest. DESIGN: An observational retrospective study. SETTING: The cardiac catheterisation laboratory, university medical school. PATIENTS: 15 subjects (8 men and 7 women, aged 25-56 years, mean 44) examined in the cardiac catheterisation laboratory, who had significant coronary artery disease years after having radiation treatment to the chest and anterior mediastinum. In the early stages of the study angiography was performed because of typical symptoms of ischaemic heart disease. Later on it was performed because of a high index of suspicion in people with signs of extensive radiation heart damage. MAIN OUTCOME MEASURES: Clinical and electrocardiographic evidence of ischaemic heart disease; echocardiographic signs of pericardial, myocardial or valvar involvement; angiographic evidence of coronary arterial stenosis, with special attention to the ostia; haemodynamic and angiographic signs of pericardial, myocardial, and valvar disease. Survival and symptomatic and functional status were ascertained after medical or surgical treatment. RESULTS: The patients were relatively young and had no risk factors. Seven patients had no signs or symptoms of ischaemic heart disease. Ten patients had ostial stenosis, which was associated with extensive involvement of other cardiac structures in nine of them. Seven required surgical treatment for coronary artery disease. Two died, one at surgery and the other one six months later. Five patients had complications associated with irradiation. CONCLUSIONS: Coronary arterial disease can be reasonably ascribed to the effects of chest irradiation when the patients are young and free from risk factors, especially if the obstructions are ostial and there is important damage to other cardiac structures. In patients with damage to other cardiac structures angina and infarction are often absent and coronary angiography seems to be mandatory. Patients often require surgical treatment and postoperative complications are common.

Adult↗
PubMed1993

[Functional maneuvers for the diagnosis of hypertrophic cardiomyopathies with and without left ventricular outflow obstruction].

PURPOSE OF THE STUDY: to assess the diagnostic value of the commonly adopted haemodynamic criteria for the diagnosis of obstructive and non-obstructive hypertrophic cardiomyopathy. PATIENTS: 16 cases of hypertrophic cardiomyopathy, 7 cases of the non-obstructive form, 16 fixed subaortic stenosis, 8 valvular aortic stenosis, and 7 cases of hypertensive heart disease. METHODS: left and right heart catheterisation, with particular attention to the pressure gradient and to the aortic pulse pressure by means of simultaneous pressure recording from the left ventricle and aorta under basal conditions, after a ventricular premature beat, during the Valsalva manoeuvre, during amyl nitrite inhalation, and isoproterenol administration. RESULTS AND CONCLUSION: the Valsalva manoeuvre increases significantly (p < 0.001) the pressure gradient, and the aortic pulse pressure in the post-extrasystolic beat decreases significantly (p < 0.001) in patients with hypertrophic obstructive cardiomyopathy. This response is significantly different from that of the other 3 disease groups. If the non-obstructive form is defined by strict criteria (i.e. no gradient above 30 mmHg even after provocative manoeuvres), then it cannot be separated from other forms of secondary left ventricular hypertrophy.

Adult↗