PubMed Health⌕ Search

Biomedical subjects

G Barboso

Publications and source records attributed to G Barboso.

At least 19 recordsLinked to original sources
PubMed2000

Proximal internal mammary in situ graft and distal coronary-coronary graft.

When a left anterior descending coronary artery passes over the cardiac apex and presents with 2 stenoses, 1 proximal and 1 distal, the available bypass conduit often is too short to enable both the anastomosis below the distal stenosis and the sequential anastomosis on the arterial segment between the 2 stenoses. In this circumstance, we graft the internal mammary artery in situ onto the proximal segment of the left anterior descending coronary artery, then use a short residual segment of the internal mammary to perform a coronary-coronary bypass of the distal stenosis. This technique also spares segments of the internal mammary for other purposes. We present our experience, together with angiographic evidence of long-term patency.

Humans↗
PubMed1999

[Immediate results of surgical treatment of proximal aortic dissection].

From 1984 to 1997, 112 patients have been operated at the Department of Cardiac Surgery of the Azienda Ospedaliera of Parma for acute dissection of ascending aorta. They were 73 males and 39 females of mean age 59.2 years (range 19-79); in the majority they presented a history of essential hypertension and atherosclerotic disease: the first diagnostic suspicion has been confirmed either by angio-CT scan or by CT scan plus aorthography and, from 1994, with transesophageal color doppler echocardiography that is becoming a valuable and precise tool wich can be used in emergency room. Bentall type composite repair or modified Bentall technique has been possible in 37 patients, while in the remaning 75, surgical aortic repair has been achieved by interposition of a dacron vascular prosthesis. Cardiac procedures that were performed in addition were coronary bypass grafthing, resuspension of the aortic valve, AVR. Total arch replacement with reimplantation of brachiocephalic vessels were performed in 6 patients and partial in 10, when intimal tear extended into the arc. Thirthythree in hospital deaths (29.4%) occurred (15 in S.O. and 18 in UCI). Follow up of the hospital survivors was conducted at a mean postoperative interval of 55 months (range 2 to 149 months with 6 late death related to aortic dissection). Our experience shows an increased incidence hypertension and aortic atherosclerosis, compared with marfan's syndrome as a source of acute aortic dissection in the late years, transesophageal echocardiography is a excellent tool for aortic dissection but it may miss dissection localized in other aortic portion, the need of an individualized and conservative surgical approach tailored to the pathology encountered.

Adult↗
PubMed1999

[Recent myocardial infarction and heart wall rupture: analysis of 21 cases surgically treated].

Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction and prognosis will depend on the prompt diagnosis by echocardiography, extension of infarct size and prompt surgical treatment. From november 1984, 21 patients (14 M, 7 F, mean age 68.4 +/- 6 years) underwent emergency operation at our Institution. Surgical technique included resection of necrotic or scarred myocardium and repair by Teflon strips-reinforced sutures, or by patching with Dacron or autologous pericardium. Associated procedures were LV aneurysmectomy, CABG, LV endoaneurysmorraphy and mitral valve replacement. Hospital mortality was 33% (7/17 pts). The postoperative course was prolonged in one patient, who needed hemodialysis and in 5 patients who needed IAPB counterpulsation. The mean length of stay in UCI was 3-10 days. Mean follow up is 70.4 +/- 41 months and 3 patients died of non cardiac related death. We conclude that despite high hospital mortality, satisfactory results may be obtained by surgical repairy under emergency condition, with good-long term survival, depending on prompt diagnosis and infarct size extension.

Aged↗
PubMed1998

A needle infixed in the heart.

A 34-year-old man self-fixed a needle into his heart, in the interventricular septum. The foreign body was localized by X-ray, echocardiography, and computed tomography. At surgical opening of the pericardial lamina, the needle was extracted with no need of cutting open the cardiac muscle.

Adult↗
PubMed1998

Cardiac Troponin T to evaluate myocardial protection via intermittent cold blood or continuous warm blood cardioplegia in coronary artery bypass grafting.

BACKGROUND: The aim of our study was to evaluate the efficacy of myocardial protection during coronary artery bypass grafting (CABG) in cold blood intermittent (CBIC) and warm continuous blood cardioplegia (WCBC). To assess myocardial necrosis, Troponin T, a structural protein belonging to the troponin complex, was measured. Troponin T is released in the blood stream 4 hours after myocardial damage, and it does not cross-react with the isomeric form of the skeletal muscle. METHODS: Our study involved 20 consecutive patients, scheduled for isolated CABG. They were divided into two groups: the first group (10 patients; 8 m, 2 f) underwent surgery with the use of CBIC, the second group (10 patients; 9 m, 1 f) with WCBC. The serum levels of cardiac Troponin T (cTn-T) were all <0.2 microg/l before operation. RESULTS: In the CBIC the mean cTn-T peaked on the 1st day after CABG, in the WCBC group the first peak occurred in the 2nd hour after arrival in the intensive care unit, and the second peak occurred on the 4th day postoperatively. The mean serum cTn-T was lower in the WCBC vs CBIC group from the 1st to the 5th day postoperatively, with a statistical difference on the 1st day (p<0.05). In the CBIC group either the cTn-T peak values (r=0.77; p<0.02) or area under the concentration curve of cTn-T release (r=0.85; p<0.004), were directly correlated with the aortic cross-clamping time. This was not demonstrated in the WCBC. CPK and CK-MB peaked in both groups 6 hours after arrival in the intensive care unit and on the 1st day postoperatively, with higher values at 6 hours in the WCBC group (p<0.05). The CK-MB/CPK ratio was significantly lower in the WCBC group at the six hours (p<0.05). CONCLUSIONS: The results of this preliminary study suggest that fewer necrosis markers are released during CABG in the WCBC group; in the CBIC group the release of cTn-T whether measured by peak serum level or by area under the curve, shows a statistically significant correlation with cross-clamping time. Warm blood cardioplegia is safe and supplies adequate myocardial protection during CABG; the more prolonged cross-clamping is, the more myocardial protection is afforded by WCBC.

Aged↗
PubMed1995

[Unilateral pulmonary embolectomy without extracorporeal circulation. A report of a clinical case].

The surgical treatment of pulmonary embolectomy is currently indicated for acute massive obstruction of the pulmonary artery with severe haemodynamic failure and, as in this case, when medical treatment with anticoagulants or thrombolytic drugs is contraindicated. In this work, the Authors focus on the technique of unilateral pulmonary embolectomy through a median sternotomy; this approach allowed an easier and safer embolectomy without extracorporeal circulation.

Embolectomy↗
PubMed1995

[Surgical treatment of saccular aneurysm of the left anterior descending coronary artery].

We report a case of a 74 old man presenting unstable angina and history of previous myocardial infarction. Coronary angiography showed significant stenoses of the left main and right coronary arteries and saccular aneurysm of the left anterior descending coronary artery. The patient underwent surgical treatment consisting in coronary artery bypass grafts and aneurysm resection. This procedure appears indicated, in author's opinion, when coronary aneurysm is saccular as in the described case.

Aged↗
PubMed1995

[Autotransfusion of the blood drained from mediastinum in the course of myocardial revascularization].

To determine if autotransfusion of unwashed shed mediastinal blood led to a reduction in the postoperative banked blood requirements were analyzed in a prospective study 82 patients undergoing myocardial revascularization during 1994 at Cardiovascular Surgery Center of Parma, randomized to receive (ATS) or not (noATS) the system. No differences were noted between two groups in terms of clinical parameters; likewise the operative characteristics were similar for the two groups. The mean 24-hours postoperative blood loss was 719.5 +/- 196 ml in the ATS group and 843 +/- 292 ml in the nonATS group (p = 0.027); the mean volume autotransfused in the ATS group was 416 +/- 167 ml. There were no reoperations for bleeding. In the nonATS group 65.8% of patients required postoperative homologous transfusions compared with 41.5% in the ATS group (p = 0.05). The mean immediate and 24-hour postoperative hemoglobin values were similar in the two groups, but at hospital discharge were 21.1 +/- 1.4 g/dL in the nonATS group and 11.3 +/- 1.4 g/dL in the ATS (p = 0.015). By logistic stepwise multiple analysis were identified as risk factors for banked blood requirement the variables: age, preoperative blood drawing patient, blood drawing before institution of cardiopulmonary bypass and postoperative blood loss. Non use of ATS was not a significant incremental risk factor for banked blood requirement, furthermore we think that use of ATS system is a primary blood volume support and confers to reduce homologous transfusions and their related complications after cardiac operations.

Aged↗
PubMed1995

[Our experience in the surgery of thoracic aorta].

Particular interest was given to 61 cases of aneurysm and all possible risks and failures of the surgical procedures were discussed. The importance of how diagnostic, technical and instrumental investigations greatly improved therapy was emphasized. The largest group of patients investigated statistically was composed of patients suffering from acute aortic dissection. Emphasis was put on how modern diagnostic technology resulted in a faster and safe procedure, keeping in mind, however, that many severe cases were still unsuccessful. With regard to traumatic lesions of the aorta, typical of young patients, the importance of a complete clinical and surgical approach was stressed in order to treat the visceral and scheletral lesions that are often present.

Aortic Dissection↗
PubMed1991

Positive inotropic effect of endothelin-2 on human atrium preparations in vitro.

The inotropic effect of endothelin-2 was investigated on isolated preparations of human atrium taken from patients undergoing cardiac surgery. Pectinate muscle fragments were set up in isolated organ chambers under isometric conditions and electrically stimulated through two ring platinum electrodes. Endothelin-2 (10(-11)-10(-8) M) increased both the force and velocity of contraction in a concentration-dependent manner, giving a maximum response of about 70% of that attainable with histamine or epinephrine. The putative endothelin B receptor agonist, the C-terminal hexapeptide endothelin-(16-21), did not affect inotropic activity. The action of endothelin-2 was not modified by indomethacin and propranolol, thus excluding an involvement of endogenous prostaglandins or catecholamines. The adenylate-cyclase activator, forskolin, and the calcium agonist, Bay K 8644, at concentrations able to enhance the inotropic effect induced by histamine and epinephrine, did not modify the action of endothelin-2. The data show that endothelin-2 has a strong positive inotropic effect on the isolated human myocardium. The effect seems to be independent of the sympathetic system and is unlikely to involve slow channel conductance or cyclic AMP. The lack of activity of endothelin fragment suggests that an endothelin receptor subtype, similar to that found in rat aorta, is present on human atrium.

Endothelins↗
PubMed1991

[Intraoperative angioplasty and bypass for the treatment of diffuse symptomatic coronary lesions].

After a brief description of the intraoperative angioplasty technique carried out together with direct revascularization through bypass with venous segments or with internal mammary (IMA) we hereby report the immediate and mid-term results obtained in 18 patients with this treatment. The simplicity of execution, having the possibility to operate on still heart and under the direct vision of the lesion the rareness of any complication, the fact that the coronary segment is open also during all checks done after 3 years from the treatment, and finally the considerable improvement in clinical symptomatology, lead the authors to consider this therapeutical succession possible in some selected cases, for which surgical operation is necessary.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Surgical therapy of post-infarct aneurysm of the left ventricle. Immediate and long-term results].

Between January 1982 and December 1986, 62 patients (59 male and 3 female) ranging in age from 37 to 69 years (mean 53) underwent resection of postinfarction left ventricular aneurysm. The indication for operation was angina in 23 cases (37%), congestive heart failure (CHF) in 7 (11.2%), angina and CHF in 29 (46.8%), rupture in 1; 2 patients were low symptomatic. Ventricular arrhythmias were present in 6 (9.7%) cases and previous systemic embolism in 4 (6.4%). Forty-seven (75.8%) patients had lesions of three coronary arteries with involvement of left main coronary artery in 4 cases; 10 (16.1%) had lesions of two vessels [left anterior descending (LAD) and/or right coronary artery]; 4 (6.4%) had only LAD artery involvement, and 1 had no significant coronary artery stenoses. Left ventricular ejection fraction (EF) was less than 0.30 in 22% of cases, between 0.30 and 0.40 in 25.4% and greater than 0.40 in 50%. The location of the aneurysm was anterolateral or apical (83.8%), posterior (14.5%) and lateral (1.6%). Left ventricular aneurysmectomy with myocardial revascularization was performed in 61 patients (bypass/patient = 2.7), with ventricular septoplasty in 20 and concomitant mitral valve replacement in 3 patients. LAD was grafted in 59.6% of anterior aneurysm. Operative mortality (30 days) was 4.8%, the late mortality, with a follow-up between 12 and 72 months (mean 38), was 6.7% and the actuarial 5 year survival rate was 85% (91% without operative mortality). In our experience, despite no evidence of any operative risk factors, no improvement was noted in radionuclide left ventricular ejection fraction in patients undergoing aneurysmectomy with ventricular septoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Non-fistulized aneurysm of the right sinus of Valsalva. Pre- and postoperative echocardiographic aspects].

The case considered concerns as 57 year-old patient who was submitted for heart tests because of a slight diastolic aortic murmur and hypertension. Echocardiographic investigation diagnosed an aneurysm of the sinus of Valsalva. The patient underwent a surgical intervention to reconstruct, on a dacron piece, the right sinus of Valsalva from which the aneurysmal cavity originated, retaining the aortic valve. After a short description of the etiology and the natural history of this condition we explain the importance of echocardiographic tests for the diagnosis and post-operative follow-up of these patients who run a high risk of severe and often lethal complications.

Aortic Aneurysm↗
PubMed1987

[Immediate and distant results of aorto-coronary bypass performed in patients with compromised cardiac contraction].

From March 1979 to December 1985 at Cardiac Surgery Department of Parma 1064 patients underwent myocardial revascularization. Of them, 82 (7.7%) with poor left ventricular function (ejection fraction less than 40%) were studied to evaluate the effects of coronary artery bypass grafting on surgical risk, survival, ventricular performance and late clinical status. Three vessels disease was present in 65.9% and severe stenosis of left main coronary artery in 21.9% of patients. There were 74 (90.2%) patients with a history of previous myocardial infarction and 8 (9.75%) with congestive heart failure. Mean ejection fraction was 32.21 +/- 3.6%. On biplane left ventricular angiography 60 (73.2%) cases had two or more akinetic segments and 22 (21.9%) only hypokinesia. Operative mortality rate was 4.9%; perioperative myocardial infarction occurred in 5 patients (6.2%). Mean follow-up was 37.64 +/- 9.23 months and survival rate, including operative mortality, was 91.3%. Among the long-term survivors 89.04% are asymptomatic and in 49% there was a significantly improvement of preoperative left ventricular ejection fraction. We conclude that myocardial revascularization should be performed also in patients with left ventricular dysfunction, because of improvement of quality of life.

Coronary Artery Bypass↗
PubMed1986

Cardiopulmonary bypass: a low T4 and T3 syndrome with blunted thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH).

Thyroid hormone serum concentrations, the thyrotropin (TSH) and prolactin (PRL) response to thyrotropin-releasing hormone (TRH) were evaluated in patients undergoing cardiopulmonary bypass (CPB) conducted in hypothermia. During CPB a marked decrease of thyroxine (T4) and triiodothyronine (T3) concentration with a concomitant increase of reverse T3 (rT3) were observed similarly to other clinical states associated with the 'low T3 syndrome'. Furthermore, in the present study elevated FT4 and FT3 concentrations were observed. In a group of patients, TRH administered during CPB at 26 degrees C elicited a markedly blunted TSH response. In these patients, PRL concentration was elevated but did not significantly increase after TRH. The increased concentrations of FT4 and FT3 were probably due to the large doses of heparin administered to these patients. Thus, the blunted response of TSH to TRH might be the consequence of the elevation of FT4 and FT3 in serum, however, other factors might play a role since also the PRL response to TRH was blocked.

Adult↗
PubMed1985

[Treatment of acute myocardial infarct by intracoronary thrombolysis and aortocoronary bypass].

Nine patients with acute myocardial infarction underwent intracoronary urokinase infusion within 3 hours after the onset of AMI, and subsequent coronary artery by pass grafting. After thrombolytic therapy 3 patients showed single-vessel disease, 2 double-vessel disease and 4 triple-vessel disease. The ventricular function was normal in 2 patients, moderately depressed in 5 and severely depressed in 2. The coronary artery by-pass grafting was performed from 6 to days after the onset of the acute myocardial infarction (average 37 days) and the average number of grafts performed per patient was 3.2. There was no operative death. The follow up period ranged from 24 to 38 months: 7 patients are in NYHA Class I and 2, symptomatic for dispnea, are in NYHA Class II. These preliminary data suggest than the coronary artery by-pass grafting after intracoronary urokinase therapy for acute myocardial infarction can be performed safely and the surgical results do not differ from those obtained with standard coronary artery by pass grafting.

Adult↗