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Biomedical subjects

F Santini

Publications and source records attributed to F Santini.

At least 19 recordsLinked to original sources
PubMed2006

Relationship between preclinical abnormalities of global and regional left ventricular function and insulin resistance in severe obesity: a Color Doppler Imaging Study.

BACKGROUND: The aim of this study was to evaluate the relationship between insulin resistance and preclinical abnormalities of the left ventricular structure and function detected in severe obesity by Color Doppler Myocardial Imaging (CDMI). Forty-eight consecutive severely obese patients (Group O) (11 males, 37 females, mean age 32.8+/-7 years) were enrolled. Forty-eight sex- and age-matched non-obese healthy subjects were also recruited as controls (Group C). All subjects underwent conventional 2D-Color Doppler echocardiography and CDMI. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance results. Obese subjects had a greater left ventricular mass index (by height) (58.8+/-14 g/m(2.7)) than controls (37+/-8 g/m(2.7)) (P<0.0001), owing to compensation response to volume overload caused by a greater cardiac output (P<0.02). Preload reserve was increased in obese subjects, as demonstrated by a significant increase in left atrial dimension (P<0.0001). Obese patients had a slightly reduced LV diastolic function (transmitral E/A ratio: Group O, 1.1+/-0.8 vs Group C, 1.5 +/-0.5; P<0.002). Cardiac deformation assessed by regional myocardial systolic strain and strain rate (SR) values was significantly lower (abnormal) in obese patients than in controls, both at the septum and lateral wall level. These strain and SR abnormalities were significantly related to body mass index. In addition, the early phase of diastolic function, evaluated using SR, was compromised in obese patients (P<0.001). The HOMA-IR values in obese patients were significantly higher (3.09+/-1.6) than those determined in the control group (0.92+/-0.5) (P<0.0001). The HOMA-IR values, in the obese group, were significantly related to systolic strain and SR values sampled at the septum level (P<0.0001). CONCLUSION: In conclusion, this study has demonstrated that obese patients pointed out systolic structural and functional abnormalities at a preclinical stage, in particular through strain and SR analysis; on the other hand, those altered CDMI parameters well distinguish obese subjects as compared with the control group. Furthermore, another main finding of the study was that myocardial deformation (systolic strain) could have a correlation with insulin resistance level.

Adult↗
PubMed2005

Genetic analysis of metamorphic and premetamorphic Xenopus ciliary marginal zone.

A major event affecting the eye during amphibian metamorphosis is an asymmetrical growth of the ventrotemporal portion of the retina compared with its dorsonasal counterpart. This event is due to an increased proliferation of the precursors of the ventral ciliary marginal zone (CMZ). Here, we analyze the expression patterns of several key homeobox genes implicated in eye development (Xrx1, Xvax2, Xsix3, Xpax6, Xchx10, Xotx2) to understand whether they are active at the time in which the metamorphic changes of the retina occur. We also analyze their expression patterns in the ventral and dorsal CMZ and compare them with bromodeoxyuridine incorporation in the CMZ. Our results suggest that the metamorphic CMZ maintains the functional subdivisions described during embryonic development. Moreover, we find that genes involved in proliferation and cell type determination of the embryonic retina are actively transcribed in the proliferating CMZ, thus indicating a potential regulatory role for these genes in the metamorphic retina.

Animals↗
PubMed2004

Serum concentrations of adiponectin and leptin in patients with thyroid dysfunctions.

Thyroid dysfunction is associated with metabolic changes that affect mass and adipocyte function, as well as lipid and carbohydrate metabolism. Adipose tissue performs complex metabolic and endocrine functions. Leptin and adiponectin are two of the most important adipocytokines, both involved in the regulation of intermediate metabolism. The aim of this study was to evaluate the relationships between thyroid status and circulating levels of the two adipose tissue hormones. We studied 15 patients with hyperthyroidism, 15 patients with hypothyroidism and 15 euthyroid subjects, all matched by sex, age and body mass index (BMI). Serum concentrations of free thyroxine, free tri-iodothyronine, thyrotropin, leptin and adiponectin and anthropometric parameters (weight, height, BMI) were assessed. No significant difference was found among the 3 groups, as assessed by Student's t-test, both for adiponectin and leptin. We conclude that metabolic changes associated with thyroid dysfunction are not related to variations in serum levels of adiponectin or leptin.

Adiponectin↗
PubMed2004

Serum haptoglobin: a novel marker of adiposity in humans.

Haptoglobin (Hp) is a glycoprotein involved in the acute phase response to inflammation. Our previous findings indicate that Hp mRNA and protein are present in the adipose tissue of rodents and that Hp gene expression is up-regulated in obese models. The aim of the present study was to establish whether Hp could be considered a marker of obesity in humans. In 312 subjects, serum Hp was correlated directly with body mass index (BMI), leptin, C-reactive protein (CRP), and age. In a multivariate stepwise regression analysis, BMI and CRP were independent determinants of serum Hp in females, with BMI having the strongest effect. CRP and age were independent determinants of serum Hp in males, although explaining only a modest percentage of the total variability. Serum Hp was positively associated with body fat, as assessed by dual-energy x-ray absorptiometry, both in female and in male groups. The level of significance improved when serum Hp was analyzed against fat mass adjusted for lean mass. Finally, Northern and Western blot analyses performed in biopsies of sc abdominal fat from 20 obese individuals showed the presence of Hp mRNA and protein in the human adipose tissue. In conclusion, serum Hp constitutes a novel marker of adiposity in humans, and the adipose tissue likely contributes to determine its levels.

Adipose Tissue↗
PubMed2003

In vitro assay of thyroid disruptors affecting TSH-stimulated adenylate cyclase activity.

Several natural or synthetic chemicals have been indicated as potential thyroid disruptors. The development of in vitro assays has been recommended to comprehensively assess the potential thyroid disrupting activity of a substance or a complex mixture. In this study, 12 substances suspected for acting as thyroid disruptors were tested for their ability to inhibit TSH-stimulated cAMP production in vitro. Those substances producing an inhibition were further studied to establish the level at which they interfere with this step of thyroid cell function. Using Chinese hamster ovary cells (CHO) transfected with the recombinant human TSH receptor, a dose-dependent inhibition of TSH-stimulated adenylate cyclase activity was produced by 1,1-bis-(4-chlorphenyl)-2,2,2-trichloroethan (DDT), Aroclor 1254 and Melissa Officinalis. All three substances also inhibited the cAMP production stimulated by TSH receptor antibody. Melissa Officinalis produced a significant inhibition of TSH binding to its receptor and of antibody binding to TSH, while no significant changes were produced by Aroclor 1254 or DDT in these assays. These data suggest that principles contained in Melissa Officinalis may block the binding of TSH to its receptor by acting both on the hormone and the receptor itself, while DDT and Aroclor 1254 affect cAMP production mainly at post-receptor step. In conclusion, we have developed a set of in vitro assays that allow investigation into the effect of thyroid disruptors on the TSH-mediated activation of the cAMP cascade. These assays may be useful to identify the mechanism of action of thyroid disruptors, coming beside and supporting animal studies or epidemiological surveys.

Adenylyl Cyclases↗
PubMed2002

Iopanoic acid rapidly controls type I amiodarone-induced thyrotoxicosis prior to thyroidectomy.

Amiodarone-induced thyrotoxicosis (AIT) may develop either in apparently normal thyroid glands (Type II AIT) or in the presence of sub-clinical thyroid abnormalities (either autonomous goiter or latent Graves' disease; Type I AIT). Mixed forms also occur. While Type I AIT is due to iodine-induced excess thyroid hormone synthesis, Type II AIT is a form of amiodarone (possibly iodine) -induced destructive thyroiditis. Type I AIT is usually treated by combined thionamide and potassium perchlorate therapy, but may be resistant to therapy. On the other hand, Type II AIT often responds favorably to glucocorticoids and may not require further therapy once euthyroidism has been restored. Not infrequently, however, AIT (especially Type I) is resistant to conventional treatment, and several weeks or months may elapse before euthyroidism is restored. Thyroidectomy has been carried out in Type I AIT patients, but thyroid surgery in thyrotoxic patients, especially those with underlying cardiac problems, carries a high surgical risk. In this study we describe 3 patients with Type I AIT, who were successfully treated with a short course of iopanoic acid (IOP), an oral cholecystographic agent, which is rich in iodine and is a potent inhibitor of 5'-deiodinase, resulting in a marked decrease in the peripheral tissue conversion of T4 to T3, in preparation for thyroid surgery. Euthyroidism was rapidly restored in 7-12 days, allowing a subsequent safe and uneventful thyroidectomy in all cases. These patients were then treated with L-T4 for their hypothyroidism and amiodarone was safely re-instituted. We suggest that IOP is the drug of choice in the rapid restoration of euthyroidism prior to definitive thyroidectomy in patients with drug resistant Type I AIT.

Aged↗
PubMed2001

Over twenty-year follow-up of the standard Hancock porcine bioprosthesis implanted in the mitral position.

BACKGROUND: To define the long-term results of 331 standard Hancock porcine bioprostheses implanted in the mitral position between 1973 and 1980. METHODS: Of 331 patients (225 male patients, 68%), mean age 49+/-10 years (range 14 to 69 years), 88% were in New York Heart Association functional class III or IV and 77% were in atrial fibrillation. Follow-up time extended more than 20 years (mean 13.9 years, range 0.3 to 24.7 years) for a total of 4,601 patient-years. RESULTS: Overall operative mortality was 6.3%. At 5, 10, 15, and 20 years, the actuarial survival rate of patients were 71%+/-2%, 46%+/-3%, 30%+/-3%, and 22%+/-2%, respectively. Actuarial estimates of freedom from structural valve deterioration were 95%+/-1%, 67%+/-3%, 32%+/-3%, and 14%+/-3%; from reoperation were 96%+/-1%, 72%+/-3%, 36%+/-4%, and 18%+/-4%; from thromboembolism were 89%+/-2%, 82%+/-3%, 74%+/-4%, and 51%+/-2%; and from anticoagulant-related hemorrhage were 98%+/-1%, 96%+/-1%, 91%+/-1%, and 86%+/-4%. Estimates of freedom from all valve-related mortality at 5, 10, 15, and 20 years were 89%+/-2%, 76%+/-3%, 64%+/-4%, and 48%+/-4%. Multivariate analysis showed younger age to be a significant risk factor for reoperation. Age at operation did not correlate with structural valve deterioration. CONCLUSIONS: The long-term results with the standard Hancock bioprosthesis implanted in the mitral position appear satisfactory, particularly up to 15 years from implantation. Protection from stroke, anticoagulant hemorrhage, and endocarditis was good.

Adolescent↗
PubMed2001

Long-term results after aortic valve replacement with the Biocor PSB stentless xenograft in the elderly.

BACKGROUND: This study seeks to define the long-term results after Biocor PSB stentless aortic valve replacement (AVR) in elderly patients, including the effects of No-React treatment. METHODS: We reviewed the outcomes of 106 consecutive patients, aged 70+/-6 years, having Biocor PSB (93 standard, 13 No-React) AVR between October 1992 and October 1996. RESULTS: There were three early deaths (3%) and 15 late deaths (15%), during a mean follow-up of 5.8+/-1.6 years. At 8 years, survival was 82%+/-4% and freedom from cardiac death was 94%+/-3%. Freedom from valve failure was 92%+/-4% at 8 years (No-React: 92%+/-8% at 4 years). Replacement of the xenograft was required in 5 patients. Freedom from reoperation was 91%+/-4% at 8 years (No-React: 92%+/-8% at 4 years). Four bleeding and two embolic events were recorded: overall valve-related event-free survival was 81%+/-7% at 8 years (No-React: 76%+/-12% at 4 years). Age of long-term survivors averaged 77+/-5 years and their New York Heart Association status was 1.3+/-0.6 (versus 2.9+/-0.6 preoperatively, p = 0.01). CONCLUSIONS: Satisfactory freedom from cardiac events and from valve deterioration added to uniform improvement in functional status despite advanced age and high prevalence of comorbid conditions make AVR with the Biocor PSB xenograft a valid long-term therapy for the elderly. No-React treatment does not influence xenograft durability.

Adult↗
PubMed2001

Evidence for a role of the type III-iodothyronine deiodinase in the regulation of 3,5,3'-triiodothyronine content in the human central nervous system.

OBJECTIVE: Thyroid hormone is essential for maintaining normal neurological functions both during development and in adult life. Type III-iodothyronine deiodinase (D3) degrades thyroid hormones by converting thyroxine and 3,5,3'-triiodothyroinine (T3) to inactive metabolites. A regional expression of D3 activity has been observed in the human central nervous system (CNS), and a critical role for D3 has been suggested in the regulation of local T3 content in concert with other enzymes. DESIGN: This study was undertaken to further characterize D3 activity in human CNS and to understand its role in the local regulation of T3 content. METHODS: Autoptic specimens from various areas of human CNS were obtained 6--27 h postmortem from 14 donors who died from cardiovascular accident, neoplastic disease or infectious disease. D3 was determined by measuring the conversion of T3 to 3,3'-diiodothyronine. The T3 content was measured by radioimmunoassay in ethanol extracts, using a specific antiserum. RESULTS: High levels of D3 activity were observed in hippocampus and temporal cortex, lower levels being found in the thalamus, hypothalamus, midbrain cerebellum, parietal and frontal cortex, and brain stem. An inverse relationship between D3 activity and T3 content in these areas was demonstrated. CONCLUSIONS: We have concluded that D3 contributes to the local regulation of T3 content in the human CNS.

Adolescent↗
PubMed2001

Autoantibodies from patients with autoimmune thyroid disease do not interfere with the activity of the human iodide symporter gene stably transfected in CHO cells.

OBJECTIVE: The human sodium iodide symporter (hNIS) is a candidate autoantigen in autoimmune thyroid diseases. To investigate the possible existence of autoantibodies able to interfere with the biological activity of hNIS, an assay was developed using a cell line stably expressing hNIS. METHODS: hNIS complementary cDNA cloned in pcDNA3 and a neomycin resistance gene vector were co-transfected into CHO cells. After selection with geneticin, a cell line termed PA4, showing the highest level of Na(125)I uptake, was characterized. The time course of iodide uptake was evaluated by incubating PA(4) cells with 10 micromol/l NaI and 0.1 microCi Na(125)I for a period up to 90 min. The accumulation of iodide increased linearly between 2 and 10 min, reaching a plateau at 45 min. The curve of iodide efflux mirrored that of iodide influx. Both perchlorate and thiocyanate inhibited iodide uptake in PA(4) cells in a dose-dependent manner starting from concentrations as low as 0.01 and 0.1 micromol/l respectively and complete inhibition was obtained at concentrations of 100 micromol/l perchlorate and 1000 micromol/l thiocyanate. The sensitivity of the inhibition assay was further improved using both inhibitors after 5 min incubation and in the absence of cold NaI. RESULTS: Included in the study were 42 patients with Graves' disease (25 had active hyperthyroidism, ten were euthyroid and seven had hypothyroidism); 34 patients with Hashimoto's thyroiditis (one was euthyroid, four had subclinical hypothyroidism and 29 were overtly hypothyroid); and 19 with atrophic thyroiditis (all hypothyroid). Four out of eight whole sera from patients with Hashimoto's thyroiditis, and 8 out of 25 whole sera from patients with Graves' disease caused an inhibition of iodide uptake in PA(4) cells greater than 20% but also in 4 out of 15 sera from normal subjects. This inhibition activity exerted by sera from patients and controls was lost after dialyzing against buffer. Accordingly, IgGs purified from sera of all patients with Graves' disease and with Hashimoto's thyroiditis or atrophic thyroiditis were devoid of any effect on iodide uptake. CONCLUSIONS: In conclusion, we believe that autoantibodies able to block the function of hNIS are very rare.

Animals↗
PubMed2001

Long-term results with the Xenomedica porcine bioprosthesis in the mitral position.

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate our clinical experience with the Xenomedica heart valve prosthesis, a low-pressure glutaraldehyde-preserved porcine aortic valve with low-profile mounting. METHODS: Between January 1983 and July 1990, 242 consecutive patients (75 men, 167 women; mean age 59.8+/-8.0 years; range: 32-77 years) underwent mitral valve replacement with the Xenomedica prosthesis. Preoperatively, patients were in NYHA classes III (66%) and IV (26%); 94 patients (39%) had undergone previous cardiac surgery and 201 (83%) had chronic atrial fibrillation. Etiology was rheumatic in 51%, myxomatous in 7%, ischemic in 1%, endocarditis in 2%, and due to dysfunction of a previously implanted device in 39%. In total, 115 (47%) patients underwent an associated procedure. Mean follow up was 142+/-24 months (range: 2-181 months); total follow up was 2,627 patient-years. RESULTS: Early mortality was 8.2% (14 patients with low-output syndrome, three with multi-organ failure, one with stroke and two with major bleeding, 2). Late mortality was 45% (3.8%/pt-year) (84 cardiac deaths, 38 being valve-related). Actuarial survival at 5, 10 and 15 years was 69+/-3%, 52+/-3% and 38+/-4%, respectively. Actuarial estimates of freedom from structural valve deterioration (SVD) at 5, 10 and 15 years were 93+/-2%, 64+/-4%, and 25+/-9%; in almost all cases SVD occurred in progressive fashion. At 5, 10 and 15 years, estimates of freedom from thromboembolism were respectively 90+/-2%, 83+/-3% and 83+/-3%, for anticoagulant-related hemorrhage 96+/-1%, 88+/-3% and 88+/-3%, for endocarditis 96+/-1%, 94+/-2% and 94+/-2%, and for reoperation 93+/-2%, 67+/-4% and 54+/-6%. Estimates of freedom from all valve-related mortality at 5, 10 and 15 years were 87+/-2%, 80+/-3% and 75+/-4%. Multivariate analysis (Cox model) showed younger age to be a significant risk factor for reoperation. CONCLUSION: Long-term results with the Xenomedica device implanted in the mitral position appear in line with those achieved for other first-generation bioprostheses. However, incidence of primary tissue failure within 10 years was unsatisfactory. Although sudden dysfunction of the device never occurred, close monitoring of survivors is warranted.

Actuarial Analysis↗
PubMed2001

Comparison of late outcome after stentless versus stented xenograft aortic valve replacement.

The long-term outcomes of 292 patients having stented xenograft aortic valve replacement (AVR) (group 1) and 376 having stentless AVR (group 2) were compared. Patients in group 1 were older (75 +/- 9 years v 70 +/- 6 years, P =.01), had more advanced cardiac disease (New York Heart Association [NYHA] classification III-IV: 85% v 75%, P =.03), and more associated procedures (53% v 41%, P =.01). Early mortality was higher in Group 1 (6.2% v 2.6%, P =.02), primarily due to cardiac cause (5.4% v 1.5%, P =.009). During follow-up (37 +/- 30 months v 43 +/- 35 months, P = not significant [ns]), 66 late deaths were recorded (12% v 9%, P = ns). At 8 years, survival (70% +/- 5% v 81% +/- 3%, P =.01) freedom from cardiac death (85% +/- 1% v 92% +/- 3%, P =.02) and prosthesis-related death (79% +/- 5% v 95% +/- 2%, P =.004) was higher in Group 2, but freedom from structural deterioration was similar (92% +/- 5% v 93% +/- 3%, P = ns). Late functional status was equally satisfactory (NYHA classification I-II: 89% v 90%, P = ns). Stentless AVR may confer selective survival advantages. Because freedom from valve failure is similar to stented xenografts, extension of stentless AVR to patients without anatomic contraindications appears justified.

Actuarial Analysis↗
PubMed2000

Effect of substitution pattern on 1H, 13C NMR chemical shifts and 1J(CH) coupling constants in heparin derivatives.

1H, 13C NMR chemical shifts and 1J(CH) coupling constants were measured for derivatives of heparin containing various sulfation patterns. 1H and 13C chemical shifts varied considerably after introducing electronegative sulfate groups. Chemical shifts of protons linked to carbons changed by up to 1 ppm on substitution with O- and N-sulfate or acetyl groups. Differences up to 10 ppm were detected for 13C chemical shifts in substituted glucosamine, but a less clear dependence was found in iduronate. 1J(CH) values formed two groups, corresponding to either sulfation or non-sulfation at positions 2 and 3 of glucosamine. O-sulfation caused increases up to 6 Hz in 1J(CH) and N-sulfation decreases up to 4 Hz. N-acetylation gave similar 1J(CH) values to N-sulfation. At positions 2 and 3 of iduronate the trend was less marked; 1J(CH) for O-sulfated positions usually increasing. Introduction of sulfate groups influences chemical shift and 1J(CH) values at the position of substitution, but also at more remote positions. 1J(CH) at the glycosidic linkage positions varied between free-amino and N-sulfated compounds, by up to 9 Hz. These results and changes in chemical shift values suggest that iduronate residues and the glycosidic linkages are affected, indicating overall conformational change. This may have important implications for biological activities.

Acetylation↗
PubMed2000

Adhesion of immature and mature T cells induces in human thymic epithelial cells (TEC) activation of IL-6 gene trascription factors (NF-kappaB and NF-IL6) and IL-6 gene expression: role of alpha3beta1 and alpha6beta4 integrins.

T cell precursors homed to thymus develop in close contact with stromal cells. Among them, thymic epithelial cells (TEC) are known to exert dominant roles in their survival and functional shaping. Key molecules mediating TEC/thymocytes interactions include cytokines and growth factors secreted by the two cell types and adhesion receptors mediating cell contact. Signaling events triggered in thymocytes by adhesion to epithelial cells have been extensively investigated, whereas little is known on the opposite phenomenon. We have previously investigated this issue in a co-culture system composed of TEC cultures derived from human normal thymus and heterologous thymocytes. We demonstrated that thymocytes adhere to TEC involving beta1 and beta4 integrins and induce the clustering of alpha3beta1 and alpha6beta4 heterodimers at the TEC surface. In addition thymocyte adhesion was followed by activation of NF-kappaB and NF-IL6 gene transcription factors and enhanced IL-6 production. The two latter phenomena were reproduced by the cross-linking of the alpha3, alpha6, beta1 and beta4 integrins, thus implying that the alpha3beta1 and alpha6beta4 heterodimers can signal during thymocyte adhesion. We have extended our previous work investigating in the same experimental setting the inducing activity of non stimulated or activated policlonal or clonal mature T cells as representative of the more mature thymocyte subset. We found that adhesion of unstimulated T cell i) involved beta1, but not beta4 integrin functions at the surface ii) induced the clustering of alpha3beta1, but not alpha2beta1 heterodimers at the TEC surface and iii) up-regulated the nuclear binding activity of NF-kappaB transcription factor and the IL-6 secretion. We propose that alpha3beta1 and alpha6beta4 heterodimers are induced to cluster at the TEC surface recognizing yet unknown cellular ligands differentially expressed during T cell development.

Antigens, Surface↗
PubMed2000

Selective recruitment of arrestin-3 to clathrin coated pits upon stimulation of G protein-coupled receptors.

Non-visual arrestins (arrestin-2 and arrestin-3) play critical roles in the desensitization and internalization of many G protein-coupled receptors. In vitro experiments have shown that both non-visual arrestins bind with high and approximately comparable affinities to activated, phosphorylated forms of receptors. They also exhibit high affinity binding, again of comparable magnitude, to clathrin. Further, agonist-promoted internalization of many receptors has been found to be stimulated by exogenous over-expression of either arrestin2 or arrestin3. The existence of multiple arrestins raises the question whether stimulated receptors are selective for a specific endogenous arrestin under more physiological conditions. Here we address this question in RBL-2H3 cells, a cell line that expresses comparable levels of endogenous arrestin-2 and arrestin-3. When (beta)(2)-adrenergic receptors are stably expressed in these cells the receptors internalize efficiently following agonist stimulation. However, by immunofluorescence microscopy we determine that only arrestin-3, but not arrestin-2, is rapidly recruited to clathrin coated pits upon receptor stimulation. Similarly, in RBL-2H3 cells that stably express physiological levels of m1AChR, the addition of carbachol selectively induces the localization of arrestin-3, but not arrestin-2, to coated pits. Thus, this work demonstrates coupling of G protein-coupled receptors to a specific non-visual arrestin in an in vivo setting.

Arrestins↗
PubMed2000

[Neurologic outcome in infants surgically treated for congenital cardiopathy: preliminary data].

INTRODUCTION: Both surgical techniques for correction of congenital heart diseases (CHD) and intraoperatory neurologic protection improved during the last 20 years. Nevertheless cardiac surgery is still a risk for neurologic morbidity. METHODS AND PATIENTS: Analysis of the postoperative neurologic status of infants younger than 6 months who underwent cardiac surgery from January 1998 to December 1999. We reviewed the EEG tracings, cranial ultrasound reports (CUS) and CT scans of 48 patients. Diagnoses were: ventricular septal defect = 15, Fallot (TOF) = 9, patent ductus arteriosus (PDA) = 5, coarctation of aorta = 4, atrio-ventricular septal defect = 4, transposition of great arteries (TGA) = 3, hypoplastic left heart syndrome = 2, pulmonary atresia = 2, total anomalous pulmonary veins drainage = 2, double outlet right ventricle = 1, cor triatriatum = 1. Mean age (range) at intervention was 54 days (2-150), 44 infants (91.7%) survived at follow-up: 23 EEG, 22 CUS and 2 CT were performed in the recent postoperative. Among survivors 5/44 had neurologic complications. EEG was altered in 4: two of them (1 TOF, 1 TGA) had pathologic CUS and CT as well (ischemic pattern in the former, atrophy in the latter). Finally a preterm newborn with PDA had mild abnormalities at CUS. After a mean follow-up of 16 +/- 6 months 3/5 patients had mild-to-moderate psychomotor delay and 2 recovered. CONCLUSIONS: According to our preliminary data the prevalence of neurologic complications in infants who undergo cardiac surgery seems to be low. The pathological findings of the recent postoperative seem to recover up to normalization in some cases at mid-term follow-up. As expected, permanent complications effect more often complex CHD. Further follow-up studies to school age will be mandatory to check the very final results of cardiac surgery performed during early infancy.

Electroencephalography↗
PubMed1999

Pulmonary autograft replacement of the bicuspid aortic valve: a successful surgical option for young adults.

A severely dysfunctioning congenitally bicuspid aortic valve may require surgical treatment within the fourth decade of life. Among conventional options, the pulmonary autograft (PA) offers many theoretical advantages particularly for young patients, including potential for growth, hemodynamic performance, no need for anticoagulants and freedom from endocarditis. However the operation is more complex and longer, may interfere with coronary and right ventricular anatomy and function and may expose the patient to the downside of two valves at risk. Aim of this retrospective study was to evaluate the mid-term results achieved with the PA performed in adolescents and young adults with a bicuspid aortic valve. Between July 94 and June 98, 26 patients, 22 males and four females, with a mean age of 24+/-10 years (range, 11 to 38), underwent bicuspid aortic valve replacement with a pulmonary autograft (stenosis 2-8%; insufficiency 13-50%; combined 11-42%). Eight patients (31%) were in NYHA FC I, 17 (65%) in II, and 1 (4%) in III. Mean preoperative ejection fraction was 67+/-7%. Three patients (11.5%) had a past medical history of endocarditis (healed in all) and in two the PA was a re-do procedure. The PA was inserted as a subcoronary implant in one case (4%) and utilized as a root in the remaining 25 (96%). The right ventricular outflow tract was reconstructed with a cryopreserved pulmonary homograft conduit in all cases. Mean cardiopulmonary bypass and aortic crossclamp times were 204+/-50 min (range, 174 to 300) and 157+/-35 min (range, 133 to 193) respectively. No early or late deaths had occurred at a mean follow-up of 22.5 months (range, 5 to 47.5). The first patient in the series (4%) was reexplored for bleeding and needed transfusions. The subsequent routine use medical and surgical strategies resulted in no further need for postoperative reexploration, and successful containment of total postoperative blood loss (<350 ml/m2BSA). 2-D Echo evaluation of neo-aortic valve competence at 6 months, revealed no evidence of aortic valve regurgitation in 17 (65%), trivial regurgitation in seven (27%), mild in one (4%) and mild-to-moderate in one (4%). The latter patient (subcoronary implant PA) required reoperation. At six months, the mean degree of regression of left ventricular mass compared to pre-operative data, was 36% (333+/-94 to 212+/-60 gr, p<0.05). All patients are asymptomatic, in NYHA FC I, and enjoy normal social interaction. In conclusion, PA root implantation can be offered as a low-risk alternative to conventional prosthetic aortic valve replacement to adolescents and young adults with a bicuspid aortic valve. The routine achievement of blood loss containment has minimized the risk of transfusion thus contributing to expand the indication in young patients. Continued patients evaluation particularly with regard to evidence of neo-aortic valve degeneration, root dilatation and homograft dysfunction in the long term is warranted.

Adolescent↗