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G Morocutti

Publications and source records attributed to G Morocutti.

42 records · Page 3Linked to original sources
PubMed1995

[Percutaneous closure of congenital and iatrogenic coronary arterial fistulas].

Coronary arteriovenous fistulas (CAF) are the most common hemodinamically significant congenital coronary anomalies. Surgery has been the only therapeutic option for ages. We describe three cases of percutaneous occlusion of CAF, congenital and iatrogenic, that we treated with different devices, to fit their different anatomic and functional characteristics. Case 1). Male patient (pt) 20 years old, asymptomatic, affected with CAF between the right coronary artery and the right ventricle, with aneurysmatic vessel dilatation and occlusion of the posterolateral branches. CAF has been occluded with a detachable, valvulated latex balloon, wedged into the proximal neck of the aneurysm. Case 2). Female pt 63 years old, who was symptomatic for exertion angina, affected with multiple CAF which originated from proximal and distal circumflex artery, proximal left anterior descending artery (LAD), all of which flowed into the left inferior lobar pulmonary artery. The fistulas have been occluded with steel and tungsten coils. Case 3). Male pt 62 years old, who underwent orthotopic cardiac transplantation in 1990 for dilated cardiomyopathy. Coronary angiogram at one year was normal, but subsequently a multilocular CAF between LAD in the middle portion and the right ventricle became evident. During angiographic follow-up an increase of the size of the fistula was observed, together with a reduction of that of distal LAD. For this reason a percutaneous occlusion with multiple tungsten coil has been performed. The three procedures have had a favorable outcome and we did not observe any acute or late complications; clinical and angiographic follow-up confirmed this satisfactory results at six months. Based on the data of the literature and on this experience, we conclude that percutaneous occlusion is the first line therapy of CAF and that the different devices can be tailored to meet different anatomic and functional characteristics.

Adult↗
PubMed1994

[Primary percutaneous transluminal coronary angioplasty in acute myocardial infarction: immediate and short-term results. National experience].

Direct percutaneous transluminal coronary angioplasty (PTCA) in the early phase of acute myocardial infarction (AMI) has till now a relatively limited use, mainly because of logistic problems, in comparison with systemic thrombolysis. The aim of this paper was to discuss the role direct PTCA during AMI, based on the most recent international experience. In brief, the major benefits of direct PTCA are the high percentage of recanalization (90%), optimal recanalization quality, the absence of contraindications in most cases; in patients with cardiogenic shock the mortality is lowered from 80% to 40-45%; absence of haemorrhagic stroke and lower incidence of cardiac ischemic events and urgent coronary artery bypass grafting (CABG) are seen in short-term follow-up. We also present the whole series of 22 Italian centers, all of which has wide experience of PTCA, but not performing it on a routine bases in AMI. It concerns of 721 patients, 389 with single-vessel disease, 198 with double-vessel disease and 105 with triple-vessel disease. Twenty patients presented left main disease and 147 patients were in cardiogenic shock. Palmaz-Schatz stent was implanted in 31 cases; 3 Simpson atherectomy were performed. In 24 cases the PTCA was carried out as a "bridge" to emergency CABG, in the presence of triple-vessel disease. Among the group without cardiogenic shock 400 procedures were direct, 164 were rescue PTCA (within 12 hours). Angiographic success (residual stenosis < or = 50%) was obtained in 92 e 89% of cases respectively. In 147 patients with cardiogenic shock success was 74%. Mortality was 2.8% in patients without shock and 48% in patients with shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1992

[Paroxysmal atrial arrhythmias in arrhythmogenic cardiomyopathy of the right ventricle with a familial character: the role of right atrial involvement].

Arrhythmogenic right ventricular cardiomyopathy presents a rather frequent familial occurrence. In the present study the cases of two brothers (25 and 30 years old, respectively) presenting with the peculiar finding of early involvement of right atrium, are described. Both subjects were investigated because of recurrent complex arrhythmias, including supraventricular (sustained atrial flutter, atrial tachycardia) and ventricular tachyarrhythmias (very frequent premature beats, nonsustained ventricular tachycardia). The associated echo-angiographic aspects of the right atrium and right ventricle were those typically described in arrhythmogenic right ventricular cardiomyopathy. The familial occurrence of simultaneous right atrial and ventricular involvement, to the best of our knowledge not previously described, can likely be due to the similar phenotypic expression of the same genotype. The prognostic significance of atrial involvement in right ventricular arrhythmogenic dysplasia is still to be defined and the clinical follow-up of these two cases may contribute to it.

Adult↗
PubMedDate not supplied

Open heart surgery in patients with dialysis-dependent renal insufficiency.

OBJECTIVE: Chronic renal failure (CRF) is commonly considered a significant factor for increased morbidity and mortality after cardiac surgery. METHODS: To assess the risk in our population we retrospectively analyzed 28 patients (16 men and 12 women, mean age 58.1+/-10.8 years) with end-stage renal disease (ESRD) undergoing cardiac surgery between 1989 and 2001. Sixteen (57.2%) patients had isolated coronary artery bypass grafting (CABG), nine (32.1%) had isolated valve replacement, and three (10.7%) underwent combined CABG and valve replacement. Preoperatively, 20 (71.4%) patients were on hemodialysis and eight (28.6%) on peritoneal dialysis. Mean preoperative duration of dialysis was 38.7+/-24.9 months (range, 3 to 93 months). RESULTS: There were two perioperative deaths (30-day mortality, 7.1%). Actuarial survival at 1, 2, 5, and 12 years was 0.85+/-0.7, 0.73+/-0.10, 0.65+/-0.12, and 0.54+/-0.14, respectively. Among 22 survivors, mean NYHA class was 1.7+/-0.8 (p < 0.001 vs. preoperatively) and mean CCS class was 1.6+/-0.6 (p < 0.001 vs. preoperatively). CCS/NYHA functional class IV (p = 0.01), urgent/emergency operation (p < 0.001), LVEF < 35% (p < 0.001) were strongly related to early and late mortality. CONCLUSIONS: Open-heart operations can be performed with acceptable short- and long-term results in patients with CRF on dialysis. Adequate preoperative management with identification of high-risk patients and a more aggressive approach before the onset of symptoms of cardiac failure are advisable.

Actuarial Analysis↗
PubMedDate not supplied

Signal-averaged electrocardiography and Doppler echocardiographic study in predicting acute rejection in heart transplantation.

BACKGROUND AND METHODS: In a prospective protocol for noninvasive diagnosis of acute cardiac rejection, 83 routine endomyocardial biopsies, followed each time by the analysis of signal-averaged electrocardiography and by a cardiac Doppler echocardiographic study, were performed in 18 heart transplant recipients. The follow-up time was 5 +/- 3.6 months. To detect noninvasively acute cardiac rejection, we compared biopsy findings with the presence of late potentials at signal-averaged electrocardiography and with two diastolic indexes, pressure half-time, and isovolumic relaxation time obtained from Doppler echocardiographic study. RESULTS: Thirteen acute rejection crises requiring modification of immunosuppression were diagnosed by means of endomyocardial biopsy. This clinically relevant acute cardiac rejection was associated with the presence of late potentials in 69% of cases and with the presence of pressure half-time < or = 55 msec and isovolumic relaxation time < or = 60 msec in 69% and 62% of cases, respectively. Sensitivity and specificity were as follows: for late potentials, 69% and 71%; for pressure half-time < or = 55 msec, 69% and 76%; for isovolumic relaxation time < or = 60 msec, 62% and 83%, respectively. The presence in a single patient of at least one abnormal parameter showed a sensitivity of 100% and a specificity of 60% in detecting important rejection. CONCLUSIONS: These data support the use of combined signal-averaged electrocardiography and Doppler echocardiographic study of the left ventricular diastolic function in the screening of acute cardiac rejection. Such results can suggest when endomyocardial biopsy should be performed, with the reliance that a normal noninvasive study highly excludes the presence of acute cardiac rejection requiring intensified immunosuppression.

Adult↗