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G Morocutti

Publications and source records attributed to G Morocutti.

At least 37 records · Page 2Linked to original sources
PubMed2000

Clinical and hemodynamic evaluation of 21 mm and 23 mm Cryolife-O'Brien stentless bioprostheses implanted in the aortic position.

BACKGROUND: The aim of this study was to investigate early and mid-term results after aortic valve replacement with Cryolife-O'Brien stentless bioprosthesis, model 300. METHODS: Records of 59 patients who received a 21 or 23 mm (Group A) aortic Cryolife-O'Brien stentless valve were retrospectively reviewed and compared to 54 patients who received a valve > or = 25 mm (Group B). Group A patients were mainly female (p < 0.001), were older (p = 0.034), had dominant aortic stenosis (p = 0.011), and a smaller (p < 0.001) body surface area. Effective orifice area index was larger (p = 0.041) and left ventricular mass index higher (p = 0.024) in Group B. RESULTS: The actuarial survival at 5.5 years was 94.9 +/- 2.3% and 92.5 +/- 4.3% in Group A and B respectively (p = NS). The actuarial freedom from all events was 85.1 +/- 6.1% and 88.2 +/- 5.2% in Group A vs Group B respectively (p = NS). At late echocardiographic studies performed between 4 and 42 months (mean 27.3 +/- 6.1 months) postoperatively, peak and mean gradients decreased and effective orifice area index increased over the follow-up period (p = NS between groups). Left ventricular mass index decreased by 25% (p < 0.001) in Group A and by 20% (p < 0.001) in Group B from preoperatively and a further 13% (p = 0.034) and 8.5% (p = 0.004), respectively, from the early to the late study. No significant difference in left ventricular mass regression was noticed between groups (p = NS). CONCLUSIONS: The Cryolife-O'Brien porcine stentless bioprosthesis showed satisfactory mid-term results and may represent a good choice for patients with a small aortic annulus selected for a biological valve.

Aged↗
PubMed2000

[Coronary angioplasty compared with aortocoronary bypass in patients with multivascular coronary disease].

Over the past two decades the use of angioplasty has rapidly expanded. As technology and experience have advanced, operators are increasingly faced with two-vessel and three-vessel disease. Coronary artery bypass graft surgery and coronary balloon angioplasty are two possible approaches for patients with multivessel coronary disease. Randomized trials comparing these two different procedures have found no difference in early as well as late mortality between assigned treatment groups. The Bypass Angioplasty Revascularization Investigation (BARI) showed a better long-term outcome with coronary artery bypass in the subgroup of patients with treated diabetes (35% died within 5 years after angioplasty compared with 19% who underwent surgery). Repeat revascularization was more common after angioplasty. Surgery offers more complete revascularization, but morbidity is higher; angioplasty is less invasive but patients are more likely to need another revascularization procedure mainly related to the occurrence of restenosis. Restenosis is often associated with the recurrence of symptoms requiring further revascularization. The use of stents and inhibitors of glycoprotein IIb/IIIa, minimally invasive surgical techniques and all-arterial grafting have the potential to change the scenery of coronary artery revascularization in the next few years.

Angioplasty, Balloon, Coronary↗
PubMed2000

[Kissing-stent technique for the treatment of spontaneous coronary artery dissection].

A 60-year-old woman referred to our hospital because of increasing dyspnea and angina. Her past history included an anterior myocardial infarction, associated with a large coronary dissection of the proximal left anterior descending coronary artery. The infarction resulted in a ventricular aneurysm which was treated with surgical excision without coronary revascularization. Coronary angiography showed a linear filling defect involving the left anterior descending coronary artery. Intracoronary ultrasound revealed a long intimal tear dividing the artery into two separated lumens. A kissing-stent technique was used to preserve the anatomical and functional integrity of the main vessel as well as of the diagonal branch. Two premounted stents were positioned covering the origin of both branches of the bifurcation. Simultaneous inflation of the two balloons created a metallic new-carina, 1 cm proximal to the bifurcation. Five months later the patient was readmitted with chest pain and repeat coronary angiography demonstrated a severe in-stent restenosis. Re-coronary angioplasty resulted in a good angiographic result. At 4 months from the last procedure there is no complaint of angina.

Aortic Dissection↗
PubMed1999

[Intravascular echocardiography (ICUS) diagnosis of post-traumatic coronary dissection involving the common trunk. A case report and review of the literature].

A case is reported in which a 31-years-old man experienced coronary artery dissection with an acute anterior myocardial infarction following blunt chest trauma in a car accident. Due to ECG signs of acute myocardial infarction a coronary angiography was performed showing an abrupt occlusion of the mid part of the left anterior descending artery and a linear filling defect in the proximal portion of the vessel. Additional detailed intravascular ultrasound was performed, revealing a long intimal tear involving the left anterior descending artery and the left main. The patient underwent immediate coronary artery bypass surgery. Two vein grafts were made from aorta to the left anterior descending artery and the circumflex artery, respectively. Repeat angiography was performed early after the operation; dissection of the left main and the left anterior descending artery was still visible and the grafts to the left descending artery and the circumflex were patent.

Accidents, Traffic↗
PubMed1999

Aortic pseudocoarctation. Description of two cases.

Aortic pseudocoarctation is a rare congenital anomaly characterized by elongation and kinking of the aortic arch. Regarded as a benign condition for a long time, several reports demonstrate that complications may occur so that a careful follow-up of patients affected by aortic pseudocoarctation is mandatory. In this context we describe two patients recently evaluated in our institution and review the literature to establish the most accurate diagnostic techniques (also considering newer noninvasive imaging modalities such as transesophageal echocardiography and nuclear magnetic resonance) and to evaluate the prognosis.

Aorta, Thoracic↗
PubMed1997

Radiation exposure to patients and operators during diagnostic catheterization and coronary angioplasty.

A detailed monitoring, on the basis of single procedures, was undertaken to assess the patient exposure and the occupational doses received by the operators (cardiologist, technician, and nurse) during diagnostic coronary angiography (CAG) and percutaneous transluminal coronary angioplasty (PTCA). The occupational dose to the staff was measured at the collar level using thermoluminescent dosimeters (TLD) to examine the neck and head exposure. Patient exposure was assessed by the dose-area product (DAP in Gy/cm2) and by the skin dose (mGy) at the level of thyroid. The mean neck dose per procedure for cardiologist was about 0.05 mGy, a reasonable level to comply with the International Commission on Radiological Protection (ICRP) eye lens recommended limit. No significant differences were detected between CAG (39 procedures) and PTCA (19 procedures). Relatively high radiation doses are given to the lung of the patient with a significant ICRP lifetime risk of about 10(-3). The patients' mean DAP was 55.9 Gy/cm2 for CAG (79 procedures) and 91.8 Gy/cm2 for PTCA (31 procedures) (P < 0.01). About 70% in CAG and 48% in PTCA of the total dose resulted from the cine examination; in PTCA the total mean DAP was about 60% higher than in CAG procedures.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Measurements of productivity and efficiency of a first level director in a cardiology referral clinic. Their use in the final determination of work load in accordance with DL 29/1993].

BACKGROUND AND OBJECTIVES: The law demands that the work-load (WL) in the Public Health Service be defined, and also dictates audit criteria referring to: a) the total activities performed during the previous three years; b) the standard times (STD) required to perform the different activities; c) the degree of demand fulfillment (DDF). Aim of this study is to establish the WL of 19 cardiologists (C) operating in a referral Hospital. METHODS: We examined the years 1993-1995. We calculated all medical procedures (P) carried out by our Institute ("procedure" method), and we determined the theoretical time needed to perform them based on STD. The activities of the Coronary Unit (CCU) and of the Ward (W) have been evaluated based on the duty-time table ("presence" method). The sum of the hours calculated with the two methods is the theoretical duty-time per week (TDT = sigma P x STD Time + CCU hours + W hours). We then measured the actual duty-time (ADT). By comparing TDT and ADT we obtained an efficiency index EI = [(TDT - ADT)/TDT]%. The DDF has been estimated based on the waiting-lists. RESULTS: We noticed an increase in invasive P and related activities, and a stable trend or a small decrease in non-invasive P, except for echography. TDT was always found to be superior to ADT (1993: 731.3 vs 670; 1994: 742.7 vs 670.9; 1995: 734 vs 652.1) with an increasing IE (8.3; 9.6; 11.1 respectively). We found rather high figures for extra hours per week (mean 31.6), C time (mean 34.9) and hours lost for vacation, illness, etc. (mean 137.5/week, equal to duty-time of more than three C). When GCS was considered, the total WL was 770 hours per week, equal to a duty-time of 19.25 C. CONCLUSIONS: WL evaluation allows a better understanding of operating conditions ina ward, it is essential when C are committed to pursue specific objectives, and it represents a basis to monitor efficiency. The reliability of WL largely depends upon STD; this underscores the fundamental role of Scientific Societies to prevent a tool intended for a better utilisation of human resources from becoming a pure instrument of cost-containment.

Cardiology↗
PubMed1997

[Percutaneous occlusion of small patent ductus arteriosus with detachable Gianturco spring coils. Preliminary results].

INTRODUCTION: Botallo's duct occlusion with Gianturco coils is effective in the fistulas with max. diameter of 3.3 mm. The insertion technique does not permit to control coil positioning inside the fistula and the coil itself may migrate to the pulmonary artery. We report our experience with a new system of temporary hookup of the coil proximal end to a metal thread (Cook device) which permits to change the position of the coil or to replace it. MATERIALS AND METHODS: We treated 6 patients with persistence of Botallo's duct (O: 2-3.5 mm, mean: 2.9 mm). The duct was occluded in 5/6 patients. The coil migrated to the pulmonary artery in a case where the hookup system permitted to retrieve and then replace it with a bigger coil which was also retrieved because it was too big for the small aorta. No complications were observed. RESULTS: Follow-up chest films at 24 hours showed coil stability and color Doppler US confirmed the occlusion. The patients were discharged after 24 hours. The follow-up at 6 months confirmed the procedure success. CONCLUSIONS: The hookup system was effective to control coil positioning and to extract and replace the coils. The effectiveness of this occlusion technique would be improved if a wider range of coil sizes and types were available.

Adolescent↗
PubMed1996

Feasibility of simultaneous Tc99m sestamibi and 2D-echo cardiac imaging during dobutamine pharmacologic stress. Preliminary results in a female population.

Feasibility of simultaneous 2D-Echo and SPECT Tc99m Sestamibi imaging during dobutamine infusion was evaluated in a female population with suspected coronary artery disease and scheduled for diagnostic coronary angiography. A total of 49 consecutive subjects were studied. Patients under continuous ECG and 2D-Echo monitoring underwent standard dobutamine infusion at increasing doses to a diagnostic end-point. Tc99m Sestamibi was administered at the peak of the dobutamine effect. With this approach, 35 patients were identified correctly by 2D-Echo (Sensitivity = 60.1%; Specificity = 83.3%; Agreement = 71.4%; k = 0.43). Perfusion imaging with Tc99m Sestamibi resulted in correctly identifying 41 patients (Sensitivity = 83%; Specificity = 84%; Agreement = 83.6%; k = 0.67). Combining information obtained from the two tests resulted in increased specificity (92%) and decreased sensitivity (64%). Simultaneous assessment of perfusion and function with Tc99m Sestamibi and 2D-Echo imaging during dobutamine administration is easily performed without added risk or discomfort to the patient. Tc99m Sestamibi appeared to be slightly superior to 2D-Echo for the detection of CAD in this population, but the difference does not reach conventional statistical significance. The combined use of the two independent tests did not substantially improve the diagnostic accuracy of each method.

Adult↗
PubMed1995

[A case of radiation-induced coronary occlusion treated with elective and emergency PTCA].

We describe the case of a patient (pt) treated with radiotherapy for Hodgkin's lymphoma at the age of 17. Two years later he presented an apical AMI and underwent coronary angiography (CA) for postinfarction angina. A 40% stenosis of the left anterior descending (LAD) was found in the proximal portion and the vessel was occluded at the middle level. Septal and diagonal branches supplied collaterals to the distal LAD and left ventricular function was only mildly reduced (EF angio-ventriculographic = 52%). We successfully performed a first PTCA, but the pt was re-admitted to our hospital few days later for a new large anterior myocardial infarction with refractory hypotension and low output condition. An intraaortic balloon catheter was inserted and CA demonstrated proximal LAD occlusion; a new PTCA was then performed and the opening of the vessel was obtained after 90' from symptoms' onset. The subsequent course was uneventful and the pt was discharged after 20 days. The ejection fraction was 39%. Thirty days after, a third PTCA with Palmaz-Schatz stent implantation was necessary for unstable angina due to a restenosis of the proximal LAD. After ten months follow-up the pt is asymptomatic with negative exercise test and an angioscintigraphic EF = 47%. CA and intravascular ultrasound demonstrated nor restenosis or progression of the disease, with a good minimal luminal diameter (MLD). A review of the literature on this topic is presented. Moreover we discuss the mechanism of coronary stenosis and occlusion and the reasons for choosing PTCA in the various settings.

Adolescent↗
PubMed1995

[Transesophageal and epicardial echocardiography in the evaluation of conservative surgery of the mitral valve. Complementary methods?].

BACKGROUND: Over the last two decades several new surgical methods for repairing a regurgitant mitral valve have been proposed. Unfortunately, early applications of such techniques were not always encouraging because the evaluation in the operating room led to false optimism due to a marked difference between static and functional anatomy of the repaired valve. By means of intraoperative echocardiography, be it transesophageal or epicardial, it is now possible to assess the functional result immediately after valvuloplasty and to decide about further surgery, right at the operating table. MATERIALS AND METHODS: Thirty-six patients (mean age 61.8 years) who underwent mitral valve repair were studied; all underwent preoperative transthoracic echocardiography in the week preceding surgery, and intraoperative transesophageal echo before cardiopulmonary bypass. The surgical results were evaluated by epicardial and/or transesophageal echocardiography in the operating room, and by transthoracic and/or transesophageal approach during follow-up. RESULTS: In 5 patients with intraoperative echocardiography done before valve repair, leaflets pathology and subvalvular apparatus were better evaluated. Besides, in 3 patients the more evident calcification of the leaflets led the surgeon to decide on direct replacement rather the reconstruction of the valve. The postoperative assessment has shown an unsatisfactory correction in 8 patients (24%). In 4 of these patients an important mitral regurgitation was reported and in 2 there was a moderate regurgitation. In the last 2, a iatrogenic stenosis had resulted. Of these 8 patients, 6 underwent valve replacement using an artificial valve. The other 2 patients (one with moderate stenosis and the other with moderate regurgitation) did not undergo a second operation because of the excessive operating time taken for valvuloplasty and the advanced age of the patients. During follow-up, from 6 to 54 months, a remarkable mitral regurgitation was present in 4 patients, one being severe and the other moderate. A persistence of ventricular dilatation was present only in these patients, while in the remainder the left ventricular diameters were normal. Finally, the mitral valve area after six months was between 1.5 an d4 cm2. CONCLUSIONS: Intraoperative echocardiography, both transesophageal and epicardial, can help the surgeon by giving him useful diagnostic information, if carried out before reconstructing the mitral valve with regurgitation. Its application is even more useful if applied straight after the surgical intervention. Unsatisfactory results may be evidenced at once and the operating team will decide right at the table for further repair or replacement, thus avoiding a second operation and the relevant risks.

Aged↗
PubMed1995

[The usefulness of transesophageal echocardiography in the follow-up of patients operated on for replacement of the ascending aorta with a tubular-valvular prosthesis (Cabrol's intervention)].

OBJECTIVES: The usefulness of transesophageal echocardiography (TEE) in assessing the postoperative results of aortic root replacement (Cabrol's procedure) was evaluated. METHODS: Between 1986 and 1993, 31 patients underwent replacement of the aortic valve and ascending aorta by a composite graft using the Cabrol procedure. Twenty-six patients had annuloaortic ectasia, two type I DeBakey dissection and four type II dissection. Hospital mortality was 9.7%. Studies were performed in 18 patients, two to 70 months (mean 27.5 months) after composite graft replacement. The following features were examined: prosthetic aortic valve function, coronary graft morphology and function, tubular graft and aneurysm wrapped around morphology and dimensions, presence of intimal flap, false lumen and thrombus in the false lumen and persistence of right atrial fistula. RESULTS: Periprosthetic leakage with significant regurgitation was detected by TEE in 3 (16.6%) of 18 patients. In one patient with infected aortic graft a fistula between the periprosthetic space and the right ventricle was detected (confirmed at reoperation). In another patient occlusion of the graft for left coronary artery was noted. In three patients (16.6%) an aneurysm of the periprosthetic space with perivalvular leakage and persistence of the fistula with the right atrium was visualized. In the two patients operated for DeBakey type I dissection an intimal flap persisted distal to the graft and in one patient flow was detected in the false lumen, while it was totally obliterated in the other. CONCLUSIONS: 1) Complications after Cabrol's procedure are not infrequent; although the real importance of some of them (periprosthetic aneurysm, persistence of dissection) is uncertain, a careful follow-up may be essential to improve the long term survival. 2) TEE is a useful and well-tolerated procedure for postoperative follow-up of patients who underwent aortic root replacement with Cabrol's procedure.

Adult↗
PubMed1995

[Identification of patients at risk of post-infarction heart rupture. Clinical and therapeutic characteristics of 121 consecutive cases and review of the literature].

In patients with acute myocardial infarction (AMI) since a decrease of deaths due to arrhythmia control and pump failure, rupture of the left ventricle free wall (RPL) has gained increasing importance as a cause of death. Of 4987 patients hospitalised for AMI from January 1969 to December 1993, RPL occurred in 121 patients (2.4%) and 17.6% of total deaths from AMI are the result of this complication. RPL was found more often in women > 75 years old, with a history of hypertension and sustaining a first coronary event. Cardiac rupture occurred after transmural myocardial necrosis, usually (60%) following an anterior AMI. RPL was an early phenomenon (in 40% it occurred within the first 24 hours and in more than 80% within 5 days from symptoms onset). Although RPL is widely considered catastrophic and unexpected, in the greater number of patients it is possible to recognise symptomatic markers (pain, emesis and agitation) indicative of impending rupture. A prompt diagnosis and the consideration that rupture is usually a stuttering process must point out an aggressive approach, which can allow a surgical treatment of RPL with a likely prognosis.

Age Factors↗