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Biomedical subjects

Flavian M Lupinetti

Publications and source records attributed to Flavian M Lupinetti.

8 recordsLinked to original sources
PubMed2005

Balloon angioplasty for Blalock-Taussig shunt failure in the early postoperative period.

Blalock-Taussig shunt failure is an infrequent but devastating, and often life-threatening, postoperative complication. Percutaneous balloon angioplasty (BA) of a stenotic modified Blalock-Taussig shunt (mBTS) has been successfully used in the setting of progressive shunt failure months to years after shunt creation. Only a few case reports exist where BA was used in the early postoperative period. We report a case series of urgent balloon angioplasty for acute early postoperative mBTS failure. Five patients were performed with BA. BA was performed within the first 24 hr following mBTS placement in three patients. Mean total procedure time was 57 min (range, 34-77 min) and mean total fluoroscopic time was 13.8 min (range, 6.4-24.1 min). Immediate success, defined as increased angiographic diameter, was accomplished in 4/5 procedures. One patient died during the procedure. Two patients survived to Glenn procedure. One patient underwent redo mBTS and one died the day after the BA. In selected patients, BA can relieve acute thrombosis of mBTS. The risk for reintervention and death is high.

Anastomosis, Surgical↗
PubMed2004

Left ventricular outflow tract obstruction.

Left ventricular outflow tract obstruction can occur at the supravalvar, valvar, or subvalvar level. Each level of obstruction is associated with distinct symptomatology, natural history, and operative approach. Reconstructive techniques can usually be used with low operative risk and excellent immediate and longer-term outcomes. Valve replacement for valvar obstruction is advised when reconstruction is not possible. The Ross procedure has greatly improved the results of valve replacement in children.

Aortic Stenosis, Subvalvular↗
PubMed2004

Risk factors for surgical site infections after pediatric cardiovascular surgery.

BACKGROUND: Although risk factors for surgical site infection (SSI) after cardiovascular (CV) surgery have been well-documented among adults, few studies have been conducted in children. We performed a case-control study to identify risk factors for hospitalized SSI in children undergoing CV surgery. METHODS: National Nosocomial Infections Surveillance System criteria were used prospectively to identify cases of hospitalized SSI in patients who underwent CV surgery. Seventy-nine patients who underwent CV surgery without hospitalized SSI were randomly selected as controls. Cases were compared with controls to determine preoperative, intraoperative and postoperative risk factors for hospitalized SSI. Multivariable logistic regression was performed. RESULTS: An SSI developed in 19 of the 826 patients who underwent CV surgery (2.3 cases per 100 surgeries) during the study period. Infection was limited to soft tissue in 12, whereas deeper infection occurred in 7. Causative agents included Staphylococcus aureus (11), coagulase-negative Staphylococcus (5) and Escherichia coli (2). One patient did not have a pathogen isolated. In a multivariable analysis, duration of surgery (odds ratio, 1.4; 95% confidence interval, 1.2 to 1.8) and age <1 month (odds ratio, 14; 95% confidence interval, 3.3 to 58.4) were independently associated with SSI. CONCLUSIONS: Age <1 month and longer duration of surgery were independently associated with hospitalized SSI after CV surgery in children.

Adolescent↗
PubMed2003

Comparison of autograft and allograft aortic valve replacement in children.

OBJECTIVE: This study was undertaken to compare the clinical and hemodynamic results following aortic valve replacement with a pulmonary valve autograft (Ross procedure) or an allograft valve in children. METHODS: The records of 107 pediatric aortic valve replacements from 1994 through 2001 were reviewed, including 78 autografts and 25 allografts. Four mechanical aortic valve replacements performed during this period were excluded from analysis. RESULTS: There were 3 perioperative deaths and 1 late death. Reoperations were required in 5 autograft recipients (with autograft preservation in 4) and in 3 allograft recipients (all requiring valve re-replacement). Seven-year survival (96% in both groups) and reoperation-free survival (88% in the autograft group; 73% in the allograft group, P =.5) were not significantly different. Serial echocardiographic studies showed that in the autograft group, left ventricular outflow tract maximal velocity (2.0-1.8 m/s, P =.02) and left ventricular thickness (10.1-8.4 mm, P <.0001) fell significantly. In the allograft group, maximal velocity (2.3-3.0 m/s, P =.03) increased significantly and left ventricular thickness (9.5-9.0 mm, P =.2) showed minimal change. Analysis according to preoperative physiology (aortic stenosis versus insufficiency), congenital cardiac anatomy, number or type of previous operations, age of patient, and use of balloon valvotomy did not predict outcomes. CONCLUSIONS: Aortic valve replacement with either the autograft or allograft provides excellent clinical results in children during an intermediate duration of observation. The Ross procedure achieves a superior hemodynamic result, which may be clinically important with longer follow-up.

Adolescent↗
PubMed2003

Comparison of extracardiac Fontan techniques: pedicled pericardial tunnel versus conduit reconstruction.

OBJECTIVE: This study was designed to determine whether either of 2 alternative methods of extracardiac Fontan reconstruction provides superior results. METHODS: We reviewed 58 consecutive Fontan procedures performed between 1995 and 2001 with a pedicled pericardial tunnel (group P, n = 21) or an extracardiac conduit of polytetrafluoroethylene or allograft aorta (group C, n = 37). Operations were performed with cardiopulmonary bypass at 32 degrees C; an aortic crossclamp was applied in only 6 patients. All group P patients and 33 (89%) group C patients received fenestrations. RESULTS: The groups were similar in terms of age, weight, anatomy, and preoperative hemodynamics. There were 3 hospital deaths (5%; 70% confidence limit, 2%-30%), all in group C. Median durations of mechanical ventilation (group P, 1 day; group C, 1 day), intensive care unit stay (group P, 3 days; group C, 3 days), chest tube drainage (group P, 8 days; group C, 7 days), and hospitalization (group P, 10 days; group C, 9 days) were not significantly different. There were no late deaths. All patients received warfarin sodium, and there were no late strokes. Before the Fontan procedure, 1 patient in group P and 3 patients in group C required pacemaker implants. Of the 51 surviving patients in sinus rhythm before the Fontan procedure, only 1 patient in group C subsequently required a pacemaker. CONCLUSIONS: Extracardiac Fontan procedures with either a pericardial baffle or conduit are associated with low operative mortality and low risks of arrhythmia and late thromboembolic complication.

Aorta↗
PubMed2002

MRI of congenital heart disease: a paradigm of collaboration. new suggestions for a team approach from Madigan Army Medical Center.

Over the past decade, there has been increasing use of cardiac MRI in the evaluation of children with congenital heart disease. There has also been an increased number of radiologists and pediatric cardiologists desiring to perform cardiac MRI in the evaluation of these patients. At the present time, the number of pediatric cardiologists and radiologists fully trained in the use of MRI studies for CHD is inadequate to provide this modality at all institutions with MRI capabilities. This article describes the collaborative approach between pediatric cardiology and radiology at Madigan Army Medical Center and its implications for patient care and credentialing.

Cooperative Behavior↗
PubMed2002

Rat model of pulmonary arteriovenous malformations after right superior cavopulmonary anastomosis.

We developed a rat model of pulmonary arteriovenous malformations after cavopulmonary anastomosis. We sought to determine whether this model reproduces the angiographic and histologic features seen in the human condition. Eight Sprague-Dawley rats underwent a right superior cavopulmonary anastomosis with the use of microsurgical techniques. Between 2 and 13 mo, pulmonary angiography was performed, the animals were euthanized, and the lungs were removed. Microscopic sections of the lung were stained with an endothelial-specific antibody (von Willebrand factor). Microvessel density was determined by counting vessels staining positively for von Willebrand factor, and the shunted and nonshunted (control) lungs were compared for each animal. Pulmonary angiography revealed time-dependent development of arteriovenous malformations. Microvessel density demonstrated a time-dependent increase in the shunted lung compared with the control lung (simple linear regression of the ratio of the microvessel density of the shunted lung divided by the microvessel density of the control lung on time; R(2) = 0.79, P = 0.003). This animal model reproduces the same angiographic and microscopic features of pulmonary arteriovenous malformations that develop in humans after cavopulmonary anastomosis. This appears to be a valid model that may be used to further study etiologic mechanisms for this phenomenon.

Anastomosis, Surgical↗