PubMed Health⌕ Search

Biomedical subjects

G Locatelli

Publications and source records attributed to G Locatelli.

At least 19 recordsLinked to original sources
PubMed1979

Atrio-ventricular canal malformations. Recent surgical techniques.

Twenty patients with atrio-ventricular canal malformations (5 complete and 15 partial forms) were operated upon during the last two years, using new surgical techniques. The repair of the complete form based on a three-leaflet three-commissure mitral valve concept, was accomplished by: a) Two separate partitioning patches (one ventricular, one atrial), b) mitral and tricuspid valve attachment in between, c) no cleft sutures, d) correction of subvalvular apparatus abnormalities, e) commissuroplasty. The repair of the partial form was obtained by: a) Valvular and subvalvular repair of the lesions when present, b) patch closure of the ostium primum defect suturing on the tricuspid side. All patients survived operation and exhibited normal sinus rhythm. Residual mitral incompetence proved to be less frequent as compared to previous techniques.

Adolescent↗
PubMed1979

Transposition of the great arteries. Successful Senning's operation in 35 consecutive patients.

Mustard's operation for TGA (transposition of the great arteries) has been obstructive complications. In order to try to avoid these complications, we used Senning's operation for TGA. Our experience in 35 consecutive cases is reported. There were no operative or late deaths. Four patients had a PDA; three had a significant VSD with subpulmonary stenosis in two. Previous atrial septectomy and persistent LSVC did not represent contraindications to this procedure. The postoperative course has been smooth and uneventful in all patients. Follow-up periods of one to twenty months demonstrated sinus rhythm in all patients and there were no significant gradients between the venae cavae and the new systemic atrium in 12 reinvestigated patients. On the basis of these results, Senning's operation is recommended as a valid alternative to Mustard's operation.

Cardiac Catheterization↗
PubMed1979

Results of systemic-to-pulmonary artery anastomosis for tricuspid atresia with reduced pulmonary blood flow.

Fifty-six patients with tricuspid atresia and decreased pulmonary blood flow received a systemic-to-pulmonary artery anastomosis as a preliminary operation. Thirty-five had a Waterston shunt, 12 a Blalock-Taussig anastomosis, and nine various other procedures. The age at operation ranged from 2 days to 10 years (median 4.5 months). Pulmonary atresia was present in eight newborn infants. Four patients (7%), all less than 3 months old, died in hospital from persistent servere hypoxia despite the palliative procedure. By actuarial methods, 93% of the survivors were alive at and after one year (longest follow-up:9.8 years), while 83% had not required further palliation at and after four years from the first operation. None of the patients subsequently restudied had raised pulmonary pressure or resistances, and in most of them the pulmonary arterial tree was deemed adequate for the Fontan operation.

Age Factors↗
PubMed1979

Repair of tetralogy of Fallot after Waterston anastomosis.

Sixty-three corrective operations have been performed in patients with Tetralogy of Fallot and a previously constructed Waterston shunt. The patients were from 1.4 to 8 years of age (median 4.3 years), and the mean interval between the Waterston shunt and the repair was 39.3 +/- 16.05 months. Three patients developed pulmonary atresia and six required a second anastomosis prior to intracardiac repair. Kinking and stenosis of the right pulmonary artery at the site of the Waterston anastomosis occurred in 12 (19 percent; 70 percent confidence limits 14 to 26 percent) patients who required patch enlargement of the right pulmonary artery at repair. Seven (11 percent; 70 percent confidence limits 7 to 17 percent) patients died in the hospital and three (5 percent; 70 percent confidence limits 2 to 11 percent) during the period of late follow-up. None of the early or late deaths was specifically related to the presence of the previously performed Waterston anastomosis.

Age Factors↗
PubMed1979

[Ventricular septal defect associated with aortic regurgitation. Results and surgical considerations in pediatric age group (author's transl)].

The Authors report their experience on the surgical treatment of ventricular septal defect and aortic regurgitation. Out of 13 patients operated upon, four required aortic valve replacement; five patients were treated with plasty of the aortic leaflets and four with the only patch closure of the V.S.D. There have not been reported hospital or late deaths. In one case, after the aortic plasty, the aortic regurgitation became severe; this patient had shown clinical signs of aortic regurgitation for more than five years before the operation. The Authors emphasize the surgical aggressiveness in this lesion when the aortic regurgitation has recently showed, whereas it is preferable to delay the operation when the aortic regurgitation has been present for more than five years.

Aortic Valve Insufficiency↗
PubMed1979

[Autoptic findings and anatomo-clinical correlations in subjects who died after repair of tetralogy of Fallot (author's transl)].

The postoperative course and the post-mortem findings of a group of 30 patients who died after repair of tetralogy of Fallot were reviewed. A residual ventricular septal defect was the most common finding at the autopsy (13 patients = 43%) while a severe residual obstruction to the right ventricular outflow was found in 5 patients (17%), miscellaneous lesions in 3 (10%) and no intracardiac defects in 9 (30%). Since a residual anatomic defect is frequently responsible for the hospital mortality, prompts hemodynamic evaluation and reoperation is recommended when the postoperative course is deteriorating.

Autopsy↗
PubMed1979

Experience in palliative treatment of univentricular heart including tricuspid atresia.

Over a period of ten years 110 patients with univentricular heart, including cases with tricuspid atresia, received palliation. The overall hospital mortality was 14.5%. Late mortality during a mean follow-up period of two years, was 6%. A group of patients with univentricular heart ("complex" group: 21 cases) had numerous and significant associated anomalies which affected the surgical results (16 survivors). Eight patients were discovered to have univentricular heart only at open heart surgery (5 survivors). In the remaining patients hospital mortality was 7.4% (6/81). As compared with the natural history these results indicate that palliative surgery is still an effective type of treatment for these two severe cardiac malformations.

Heart Defects, Congenital↗
PubMed1978

Open-heart palliative surgery for pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries.

The surgical management of pulmonary atresia with ventricular septal defect (VSD) and hypoplastic pulmonary arteries poses difficult problems. Adequate palliation was achieved in two such patients by restoring continuity between the right ventricle and the pulmonary arteries by means of a woven Dacron patch. The VSD was left unrepaired. Angiography performed one month after operation showed the reconstructed pulmonary outflow tract to be widely patent and the pulmonary arteries to be enlarged. This approach may allow subsequent total correction by closure of the VSD in these hopeless patients.

Blood Vessel Prosthesis↗
PubMed1978

[Corrective surgery of double-outlet right ventricle and subaortic ventricular defect. Report of 12 cases surgically treated (author's transl)].

Experience with corrective surgery in 23 pts with double outlet right ventricle (DORV) and subaortic VSD is presented. The overall hospital mortality was 17%. Patients were divided into two groups: Group I includes seven cases without pulmonic stenosis and Group II sixteen cases with pulmonic stenosis. Six of Group II required a sistemic to pulmonary artery shunt earlier in life. Anatomic and clinical aspects in both groups are described as well as indication for surgery. The importance of angiocardiography for a precise diagnosis is emphasized. Problems related to management and complications are discussed; in particular how to avoid LVOTO in case of restrictive VSD and RVOTO in patients with pulmonic stenosis.

Adolescent↗
PubMed1978

[The Senning operation for correction of transposition of the great arteries (author's transl)].

The reported incidence of the main complications related to the Mustard operation for correction of transposition of the great arteries seems to be quite high: more than half patients develop arrhythmias and about one third develop venous (pulmonary or sistemic) obstructions. For these reasons we have reconsidered the type I (1959) Senning operation. Ten children below two years of age (body weight ranging from 3.9 to 12 Kg) have been operated on with this technique at our Institution. Nine were D-TGA and one L-TGA. One patient had a small VSD and three had mild pulmonary outflow stenosis (p less than 30 mmHg). All patients survived operation and none suffered from complications. At the time of the discharge from the Hospital all were in sinus rhythm. Late evaluation (24 hours EKG, cardiac catheterization, etc.) is in course. We believe that the Senning operation is easier to perform than the Mustard operation because of its more standardized technique which respects the internal geometry of the heart. Additional advantages are: 1) the intra-atrial conducting pathways are less likely to be damaged; 2) there is a minimal or no need for artificial tissues.

Child, Preschool↗
PubMed1978

[Renal failure and aortic coartaction. Report of two cases of newborns successfully treated (author's transl)].

Congestive heart failure may frequently occur in patients with isolated coarctation of the aorta within the first six months of life. Renal failure is on the contrary a very rare pathologic sequela. This is caused by a low renal blood flow related either to a poorly developed collateral circulation or in those instances of preductal coartation to an early closure of ductus arteriosus. Peritoneal dyalisis is very effective in these critically ill infants both in correcting biochemical abnormalitics and in supporting cardiac performance. Surgical treatment is however the only way to restore normal renal blood flow and good cardiac output. This report describes two patients with isolated coarctation of the aorta in whom renal failure developed within the first two months of life. Both patients were successfully treated by peritoneal dyalisis and subsequent surgical intervention.

Acute Kidney Injury↗
PubMed1978

The Senning operation for transposition of the great arteries.

The original Senning technique of interatrial transposition of venous return was selectively employed for physiological correction in 24 patients with transposition of the great arteries (TGA) ranging in age from 74 days to 26 months (median 7 months). Twenty-three had intact ventricular septum and one had a large ventricular septal defect and diaphragmatic subpulmonary stenosis. There were no hospital or late deaths, and at follow-up examination 1.5 to 12 months postoperatively, each patient was asymptomatic, in normal sinus rhythm, and had no clinical evidence of caval or pulmonary venous obstruction. Nine patients underwent cardiac catheterization and angiocardiographic studies between 1.3 and 9 months postoperatively which demonstrated widely patent venous pathways and effective "left" and "right" atrial contraction. This experience lends support to the continued use of the Senning technique for interatrial transposition of venous return.

Angiocardiography↗
PubMed1978

[Surgical management of ventricular septal defect and coarctation of the aorta. Observations on 40 cases, with particular references to infancy (author's transl)].

Forty patients with V.S.D. and coarctation of the aorta were operated on at Department of Cardiac Surgery, Ospedali Riuniti Bergamo. Surgical management of infants with V.S.D. and coarctation depends on the magnitude of the left to right shunt. Patients may therefore be divided into two groups: 1) those with aortic coarctation and a small V.S.D., who have normal or slightly elevated pulmonary artery pressure. If surgery is required, these patients can be successfully treated by repairing the coarctation alone. Ten cases in our series were operated on using this approach without deaths; 2) patients with coarctation and large V.S.D. and pulmonary hypertension. The management of these infants is controversial. One stage repair was used in four cases without deaths. On the other hand, nine out of 11 patients in whom the V.S.D. was left unrepaired at the same operation died, giving a 81.8% mortality rate. Repair of coarctation with simultaneous banding of the pulmonary artery was equally affected by high mortality. With this approach in 13 patients there were seven deaths, giving a 53.8% mortality rate.

Age Factors↗
PubMed1978

[Clinical use of a minicomputer in heart surgery intensive care units].

The Authors present three respiratory parameters useful to estimate the respiratory and hemodynamic conditions of a cardiac patients before these turn into obvious pathological clinical pictures. The parameters are: alveolar-arterial oxygen difference, respiratory index and arterial-venous pulmonary shunts. The sophisticated mathematic calculations necessary to calculate and to elaborate such data are made, in few seconds, by a minicomputer which is very easy to work with. A clinical example in which the above-mentioned data have been employed helps to demonstrate their extreme usefulness.

Blood Gas Analysis↗