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Biomedical subjects

G Pompilio

Publications and source records attributed to G Pompilio.

At least 37 records · Page 2Linked to original sources
PubMed1997

Effects of warm ischemia on valve endothelium.

BACKGROUND: This study investigates the time-dependent resistance of the endothelium of porcine aortic and pulmonary valves to different periods of warm ischemia (WIT). METHODS: Twenty-five 9-month-old swine were divided after death into five groups of WIT (0, 6, 12, 24, and 36 hours). Aortic and pulmonary valves were removed and a total of 15 aortic and 15 pulmonary valve specimens were obtained for each WIT interval. Valves were then examined for (1) their viability rate by the trypan blue dye exclusion method at light microscopy (percent of viability compared with 0 hours of WIT); (2) ultrastructural signs of irreversible or reversible ischemic damage by transmission electron microscopy (cell disruption, dilation of endoplasmic reticulum, cytoplasmic edema, nuclear and mitochondrial changes); (3) endothelial function by pharmacologic evaluation of both the endothelial-releasing capacity of prostacyclin and the endothelial-dependent dynamic responses to relaxing (acetylcholine from 1 x 10(-10) mol/L to 1 x 10(-4) mol/L) in aortic and pulmonary valve segments precontracted with norepinephrine (1 x 10(-6) mol/L) and contracting (NG-monomethyl-L-arginine, 1 x 10(-4) mol/L) drugs. RESULTS: Our results showed an endothelial progressive time-dependent ischemic injury, which reached significance after 12 hours of exposure. Viability and functional data indicated that 6 hours of WIT only provoked slight endothelial damage (p > 0.05 respect to time 0 hours), with signs at transmission electron microscopy consistent with a reversible injury. At 12 hours of exposure, we observed a significant reduction (p < 0.05) with respect to time 0 of the viability rate of prostacyclin production and of the endothelium-dependent dynamic responses to acetylcholine and NG-monomethyl-L-arginine. These functional impairments, although significant, were not consistent, however, with a complete loss of viability. Transmission electron microscopic observations confirmed the appearance of signs of irreversible injury; nevertheless, some elements were found to be well preserved or presented reversible damage. After 24 hours of WIT, ultrastructural and functional data were consistent with a dramatic decrease compared with controls in endothelial viability and functions (p < 0.01). Finally, after 36 hours of WIT, there was a subtotal loss of viability, of functions (p < 0.001) and, at transmission electron microscopic observations, of the endothelial layer of the valves. CONCLUSIONS: Our data show that the endothelial cells are resistant to short periods of WIT (up to 6 hours), and suggest that these cells can endure longer exposures, up to 12 hours of warm ischemia. Periods of 24 and 36 hours of WIT provoke progressive irreversible damage.

Acetylcholine↗
PubMed1997

Surgery of descending thoracic aortic aneurysms with centrifugal pump support.

Fifty-five patients with descending thoracic aortic aneurysms were operated upon between October 1987 and October 1994. All patients were supported by a centrifugal pump during operation. The mean(s.d.) duration of cross-clamping was 39(13) min. In order to evaluate the efficacy of the centrifugal pump, haemodynamic and metabolic measurements were made on four occasions (before cross-clamping, immediately after cross-clamping and before cross-clamp removal) and again after cross-clamp removal. The haemodynamic data remained stable throughout the procedure: central venous pressure (15(4.6) versus 16(4.8) versus 16(4.6) versus 15(4.6) mmHg; P = n.s.), pulmonary artery pressure (25(6.2) versus 24(5.1) versus 22(5.3) versus 23(4.4) mmHg; P = n.s.), radial systolic pressure (119(19.9) versus 116(25.2) versus 111(25.9) versus 111(20.7) mmHg; P = n.s.) and heart rate (75(12.6) versus 77(14) versus 76(15.6) versus 78(16) beats/min; P = n.s.). The acid-base status deteriorated slowly during surgery. Values before and after cross-clamping were: pH (7.42 (0.04) versus 7.37(0.06); P < 0.05), base excess (-0.67(2.20) versus -3.70(2.50); P < 0.05) and bicarbonates (24(8.9) versus 20(1.9); P < 0.05). The cerebrospinal fluid pressure remained constant: 20(5.7) versus 19(5.9) versus 18(5) versus 19(5) mmHg; P = n.s. Renal function, measured before, and at 1, 3 and 7 days after the operation also remained stable (creatinine: 1.1(0.4) versus 1.2(0.4) versus 1.2(0.4) versus 1.2(0.4); P = n.s.; blood urea nitrogen: 46(18.7) versus 46(18.6) versus 51(24.9) versus 55(27.9); P = n.s.). Step-wise multiple linear regression comparing cerebrospinal fluid pressure against haemodynamic and metabolic data showed that during aortic cross-clamping there was a significant relationship between central venous pressure (P < 0.0013) and arterial pH (P < 0.0148), while before and after cross-clamping multivariate analysis showed a relationship only between central venous pressure and cerebrospinal fluid pressure (P < 0.0035). The results confirm that centrifugal pump support is effective in stabilizing haemodynamics and protecting the kidney during thoracoabdominal aneurysm repair.

Acid-Base Equilibrium↗
PubMed1997

[Cellular viability and immune response in homologous cryopreserved cardiac valves].

BACKGROUND: Long-term durability of homograft valves is related to cellular viability and immunological compatibility. In this paper, we carry out a critical update of the relationship between cellular viability and immunology of cryopreserved homograft valves. BIOLOGICAL ISSUE: In the first section, we review the theoretical background of the superior durability of cryopreserved valves with high cellular viability, with respect to the "fresh" antibiotic-stored valves, with lower viability rates. Afterwards, a brief review of the principal factors influencing the homograft valve viability rate during harvesting, preparation, sterilization and cryopreservation phases, is performed. CELLULAR VIABILITY: In the second paragraph, we analyze the problem of cellular viability in cryopreserved valves, both for matrix cells--fibroblast--and for endothelium. In particular, we report the current methods of quantifications of viability and more recent biological researches. Correlations between biological and clinical data are also discussed. IMMUNOLOGICAL ISSUE: Finally, the immunological issue and its relationships with cellular viability is analyzed, with particular regard to experimental evidence and clinical implications. Moreover, we have described the recent hypothesis on the influence of cryopreservation on the antigenicity of tissues, and the laboratory researches on the long-term antibody response in humans after homograft valve implantation.

Cell Survival↗
PubMed1996

Retention of endothelium-dependent properties in human mammary arteries after cryopreservation.

BACKGROUND: We investigated the effects of cryopreservation and antibiotic treatment on endothelium-dependent vasomotor properties of human internal mammary arteries (IMAs). METHODS: Sixty IMA specimens from routine coronary artery bypass grafting procedures were randomly assigned to six groups. Group I (controls) were immediately tested after harvest. Remaining groups were prepared according to a stepwise design: group II, 6 hours of warm ischemia; group III, 6 hours of warm ischemia + 24 hours at 4 degrees C (without antibiotics); group IV, 6 hours of warm ischemia + 24 hours of 4 degrees C antibiotic disinfection; group V, 6 hours of warm ischemia + 24 hours at 4 degrees C (without antibiotics) + cryopreservation; and group VI, 6 hours of warm ischemia + 24 hours of 4 degrees C disinfection+cryopreservation. The IMA specimens were cut into rings and the tension of vascular smooth muscle was recorded. The IMA rings were contracted with norepinephrine (3 x 10(-6) mol/L) and tested with cumulative concentrations of acetylcholine (from 1 x 10(-9) to 1 x 10(-5) mol/L), contracted with endothelin-1 (from 1 x 10(-11) to 1 x 10(-6) mol/L), and contracted with the nitric oxide-synthase inhibitor NG-monomethyl-L-arginine (1 x 10(-4) mol/L). Rings were also tested for their capacity to generate 6-keto-prostaglandin F1 (the stable metabolite of prostacyclin), and endothelial cell viability rate was finally evaluated with the trypan blue dye exclusion method. RESULTS: Our results show that a complete cryopreservation protocol does not significantly modify (p > 0.05) the relaxant activity to acetylcholine in norepinephrine-precontracted IMA rings (controls; 90.2% +/- 4.2% vs group VI, 77.1% +/- 6.2%) or the vasoconstrictor response induced by endothelin-1 (controls, 62.6% +/- 2.8% versus group VI, 73.7% +/- 4.8%) and NG-monomethyl-L-arginine (controls, 22.4% +/- 1.5% versus group VI, 18.9% +/- 1.9%). Furthermore, IMA cryopreservation does not significantly modify (p > 0.05) the endothelial release of prostacyclin either in basal conditions (-20% versus controls) or during pharmacologic intervention with acetylcholine (-18% versus controls), endothelin-1 (-17% versus controls), and NG-monomethyl-L-arginine (-18% versus controls). CONCLUSIONS: We conclude that the IMA endothelial function does not seem significantly injured by any of the current steps of disinfection and cryopreservation.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Role of right gastroepiploic artery in myocardial revascularization with arterial grafts.

Between July 1990 and December 1992. 112 patients underwent myocardial revascularization with arterial grafts in the Department of Cardiac Surgery, University of Milan. Monovascular patients were excluded from the study. The right gastroepiploic artery was used in 44 patients (39.3%); mean age was 54.3 years and reoperation rate 18.2%. Of the 44 patients, previous myocardial infarction had occurred in 25 (57%). Emergency operation was performed in one case (2%). Mean left ventricular shortening fraction was 36% and mean ejection fraction 58.6%. Coronary artery disease was bivascular in 10 patients (23%) and trivascular in 34 (77%). The arterial revascularization in patients with gastroepiploic artery was performed using a left internal thoracic artery graft in all 44 patients; the right internal thoracic artery was used in 18 (41%) and the inferior epigastric artery in two (4%). The sites of gastroepiploic artery grafting were 55% posterior descending, 16% right coronary artery, 11% posterolateral branch, 14% circumflex and in 4% posterior descending and posterolateral as sequential graft. No patient died; postoperative myocardial infarction rate was 4%. No complications related to gastroepiploic artery utilization were noted. Forty-three (98%) of the gastroepiploic artery group underwent graft reinvestigation: the arteries were correctly visualized in 41 patients (95%) and were patent in 39 cases and stenotic in two. A mid-term postoperative stress test (mean 17.4 months) was performed in 91% of patients. Normal limits were found in 37 patients (92.5%) and an abnormal stress test result in three (7.5%). The contemporary follow-up showed no deaths or myocardial infarctions. Three patients (7%) had recurrent angina. The role of gastroepiploic artery in arterial revascularization has become fundamental, especially, it is believed, for the posterior or posterolateral left ventricular wall. The present data show the patients to be clinically and functionally well 1 year after operation.

Adult↗
PubMed1995

False hydatic aneurysm of the thoracic aorta.

In this article we report the successful treatment of a lower descending thoracic aorta hydatidosis that mimicked a posterior saccular aneurysm; surgical excision was performed and the aorta was repaired with a prosthetic Dacron patch. At a 26-month follow-up, the patient is alive and conducting a normal life. Discussion about the management of this rare case also is given.

Adult↗
PubMed1995

"Thinning-down phenomenon" and vasomotor adaptability of the inferior epigastric artery graft.

We report a case of diffuse thinning of an inferior epigastric artery early after its implantation as a coronary free graft. This phenomenon showed reversibility at the 20-month angiographic follow-up in response to progression of the proximal lesion in the recipient coronary artery. Graft vasodilation in response to atrial pacing and nitroglycerin infusion at late angiography confirmed the vasomotor adaptability of this arterial conduit.

Abdominal Muscles↗
PubMed1995

Descending thoracic aorta aneurysmectomy: left-left centrifugal pump versus simple clamping technique.

Forty-six patients who had had an elective repair of a descending thoracic aortic aneurysm were reviewed, in order to investigate the efficacy of support by a centrifugal pump on distal organ perfusion and spinal cord protection during cross-clamping of the thoracic aorta. Two concurrent groups were analysed: 36 patients (78%) were supported by left atriofemoral arterial bypass with a centrifugal pump and 10 (22%) had no distal circulatory support. No patient was fully heparinized. The demographic data and preoperative characteristics of the groups, including location and type of aneurysm, were similar. The mean(s.d.) duration of cross-clamping was 37.8 (16) min in the centrifugal pump group and 42.3(21) min in the simple clamping group. Preoperative haemodynamic and laboratory data were similar in both groups. During cross-clamping, parameters of pH and blood urea varied but were better in the centrifugal pump group; changes from pre-intervention to early aortic cross-clamping time were not significant (pH, P < 0.0006; bases, P < 0.0003). Differences in creatinine values were caused mainly by the change from pre-intervention to the first postoperative day (P < 0.03); this continued throughout the hospital stay. The cerebrospinal fluid pressure measurement indicated a significant difference in time change (P < 0.0001) and mean level over time (P < 0.0002): levels were significantly lower in the centrifugal pump group throughout aortic cross-clamping. Three patients in the simple clamping group and none in the centrifugal pump group (P < 0.02) required cerebrospinal fluid drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Thoracic↗
PubMed1995

Revascularization of the circumflex artery with the pedicled right internal thoracic artery: clinical functional and angiographic midterm results.

Retroaortic crossing of the pedicled right internal thoracic artery for revascularization of the circumflex artery used in combination with a pedicled left internal thoracic artery anastomosed to the left anterior descending artery and its branches is an attractive technique to achieve an extensive arterial revascularization of the left ventricle. However, there is a suspicion that pulling the right internal thoracic artery through the transverse sinus could compromise its blood flow capacity and patency. Between January 1990 and July 1994 this technique was applied in 256 patients (202 men, 54 women; average age 62 years, range 31 to 80 years). Sixty-one patients had two-vessel disease and 195 had three-vessel disease. Seventeen patients were undergoing a reoperation. Twenty-two had a left ventricular ejection fraction of 40% or less. Thirty had diabetes. Twenty-eight had morbid obesity. The right internal thoracic artery was directed to the circumflex artery (259 anastomoses) through the transverse sinus and the left internal thoracic artery was anastomosed to the left anterior descending artery and its branches (375 anastomoses) in all patients. The 195 patients with three-vessel disease received additional coronary artery bypass grafts to the right coronary artery (93 saphenous vein grafts, 89 free inferior epigastric artery grafts, 12 pedicled right gastroepiploic artery grafts). In total, the 256 patients received 833 distal anastomoses (average 3.2, maximum 5 per patient) and 634 distal anastomoses were internal thoracic artery anastomoses (average 2.4, maximum 4 per patient). Three patients died early and eight had a nonfatal myocardial infarction. Seven patients needed postoperative intraaortic balloon pump support. Six patients underwent early reoperation because of excessive bleeding. Sternal dehiscence occurred in four patients. One of these four patients died of the complication 10 months after the operation. No patient was lost to follow-up (average 33 months). During follow-up, two sudden deaths and six noncardiac deaths occurred. Two patients had a nonfatal myocardial infarction and 12 had recurrence of angina. There were no late reoperations. One patient underwent a successful percutaneous balloon angioplasty of a native left anterior descending artery. Seventy-four patients, enrolled in prospective angiographic studies, underwent a postoperative recatheterization (average 13.2 months, range 6 to 58 months). Seventy-three of the 74 right internal thoracic artery grafts were patent. In comparison, 74 of 74 of the left internal thoracic artery grafts (106/107 anastomoses) were patent. Maximal stress thallium-201 scintigraphy results, obtained in 25 of those patients, did not reveal ischemia in the area of the circumflex artery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1995

Ectopic thyroid tissue in the ventricular outflow tract: embryologic implications.

The case of a 66-year-old female patient with a tumor located in the right ventricular outflow tract is reported. Histologic examination of an intraoperative biopsy revealed that the tumor was an intracardiac ectopic thyroid. We performed conservative surgery with partial resection of the mass. After 5 years, the patient is asymptomatic and leading a normal life. The authors examine the relation between the embryologic development of the primitive heart and the thyroid primordium and suggest the hypothesis of ectopic thyroid location in the right- or left-ventricular outflow tract.

Aged↗
PubMed1995

Aortic arch surgery: pros and cons of selective cerebral perfusion. A multivariable analysis for cerebral injury during hypothermic circulatory arrest.

Thirty-five consecutive patients with aortic arch aneurysm who required surgical reconstruction were operated on with the aid of extracorporeal circulation between February 1985 and December 1993. Nineteen patients (54.3%) were treated with hypothermic circulatory arrest (HCA) (Group A) and 16 (45.7%) (Group B) with HCA and selective cerebral perfusion (SCP) through the carotid arteries. Preoperative characteristics didn't show any significant differences between the two groups: mean age was 58.7 +/- 12 vs 62.1 +/- 7, p = ns, male sex 73.6% vs 75%, p = ns; atherosclerotic aneurysms were 57.8% vs 43.7%, p = ns; Type A dissections 42.2% vs 56.3%, p = ns and emergency operation were 68.4% vs 43.7%, p = ns in Groups A and B respectively. For SCP, blood was infused initially at a rate of 200-300 ml/min, maintaining the 30-40% of cerebral blood flow in normothermia, successively, with the aid of transcranial Doppler sonography (TDS) SCP-flow was improved to 500-1000 ml/min. The MHz pulsed TDS was used to measure the middle cerebral artery flow velocity in deep hypothermia before the arrest, in order to adjust the SCP flow during the HCA. In all patients we used open aortic anastomosis; in two cases an extraanatomical ascending-descending aorta was required, and in other two the "elephant trunk" technique was used in case of combined aortic arch and descending aneurysms. The HCA times were similar in the two groups 47.5 +/- 22 vs 47.7 +/- 78, p = ns. Early deaths occurred in 5 patients of the Group A (26.3%) and in 3 patients of the group B (18.7%), p = ns.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Prostacyclin production by different human grafts employed in coronary operations.

Segments of human saphenous vein, internal mammary artery, right gastroepiploic artery, and inferior epigastric artery were incubated in vitro in Krebs-Henseleit solution and compared in terms of their capacity to generate and release into the medium 6-keto-prostaglandin F1 alpha (PGF1 alpha), the stable metabolite of prostacyclin. The four vascular conduits were also challenged with endothelin-1 (40 ng/mL), and accumulation of the lipidic material in the bathing fluid was also studied. The results obtained show clearly that under both normal and endothelin-1-stimulated conditions, the four vascular segments generate a substantial amount of 6-keto-PGF1 alpha. Multiple-comparisons analysis of the results indicates that the rank order in producing 6-keto-PGF1 alpha is as follows: inferior epigastric artery > internal mammary artery > right gastroepiploic artery > saphenous vein (p < 0.01). A similar order of potency was obtained in vascular conduits stimulated with endothelin-1. The rate of formation of immunoreactive 6-keto-PGF1 alpha under both normal and stimulated conditions by the inferior epigastric artery (normal, 301 +/- 8 pg/mg of tissue; stimulated, 519 +/- 15 pg/mg of tissue) was at 10 minutes more than 2 times (p < 0.01) that of the saphenous vein and about 1.5 times (p < 0.01) that of the right gastroepiploic artery.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1994

[A case of complete myocardial revascularization with different arterial grafts: right internal mammary artery, right gastroepiploic artery and inferior epigastric artery].

It has been well established that the internal thoracic artery (ITA) is a good alternative to the saphenous vein as conduit for coronary artery bypass grafting because of superior early and late patency. Many surgeons now commonly use both ITAs for CABG and many have adopted complex grafting methods such as free ITA graft and sequential anastomosis; despite these techniques, it's not always possible to achieve complete revascularization with arterial conduits. More recently the right gastroepiploic artery (rGEA) and the inferior epigastric artery (IEA) have been used as alternative arterial conduits. The authors report the experience of a case of myocardial revascularization in a patient with angina not responsive to medical therapy, severe tri-vessel coronary artery disease, which had a previous total bilateral saphenectomy; the patient was also found to have a right fibrothorax. In the surgical strategy the authors considered that the bilateral use of mammary artery could have been the cause of the depressed respiratory function and that it was important to leave intact the left hemithorax; they therefore employed the rITA in the revascularization of the anterior descending (AD). To complete the revascularization they used the IEA for a marginal branch of the circumflex artery and the rGEA for the interventricular posterior artery, branch of the right coronary artery. In this fashion good early results were obtained with absence of perioperative complications with a good life expectancy.

Coronary Angiography↗
PubMed1994

[Myocardial revascularization in aged patients: what is the surgical risk?].

There are still controversies about the surgical results of myocardial revascularization in aged population, in terms of cardiac and non-cardiac morbidity and mortality. This issue prompted us to study retrospectively 71 patients older than 75 years electively operated of coronary artery bypass grafting (CABG) from June 1990 to June 1993 (Group A). Elderly population was compared with a contemporaneous and concurrent control group of patients younger than 75 years (Group B). Patients > 75 years have been divided in successive subgroups according to the severity of coronary artery disease (3 vessel disease 67.7%, 2 vessel disease 26.7%, 1 vessel disease 5.6%), echocardiographic ejection fraction (EF > 50%: 40.8%; 50-30%: 42.2%; < 30%: 16.9%) and preoperative risk factors. Left internal thoracic artery (LITA) utilization rate was 97.1% in Group B and 57.7% in Group A (p < 0.001). Cardiopulmonary bypass circulation, aortic cross-clamping time and number of coronary anastomoses were similar in the 2 groups (2.87 +/- 0.9 versus 2.8 +/- 0.8, NS). Operative mortality rate of aged population was 4.2% while no patient of Group B died (NS). Concerning the cardiac morbidity, there were no significantly differences between the 2 groups: myocardial infarction occurred in 3 patients of Group B (4.2%) and in 5 patients of Group A (7%; NS). Atrioventricular block was also similar in the 2 groups. Non-cardiac complications occurred more frequently in the aged population group: neurologic complications in 11.2% versus 1.4% (p < 0.04), renal insufficiency in 12.6% versus 1.4% (p < 0.03) and respiratory failure in 9.8% versus 1.4% (p = 0.06). (ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1993

Intracardiac ectopic thyroid: conservative surgical treatment.

The case of a patient with an intracardiac ectopic thyroid is reported. A cardiac tumor was found in a 66-year-old woman and was diagnosed by two-dimensional echocardiography. An intraoperative biopsy was performed, and the mass was recognized as an ectopic thyroid and treated with a conservative surgical approach because of the size, location, and relationship to adjacent structures. The 60-month follow-up shows normal echocardiographic images and the good clinical status of the patient.

Aged↗
PubMed1993

Preoperative management and surgical therapy in complicated acute infective endocarditis: a 5-year experience.

Twenty-five patients underwent early and elective valve replacement for infective endocarditis during a 5-year period between April 1985 and March 1991. Indications for urgent surgical intervention performed at a mean 32 (range 6-47) days after admission were intractable heart failure, systemic emboli, septic multiorgan failure and the presence of vegetations. Indication for elective surgery was persistent (mean 42 (range 17-56) days) infection after appropriate antibiotic therapy. Twenty patients (80%) had a native valve endocarditis; five (20%) had prosthetic valve involvement. A total of 30 valvular prostheses were implanted: 22 (73.3%) were aortic (21 mechanical and one biological); eight (26.7%) were mitral (all mechanical). All unstable patients referred were treated before surgery in the intensive care unit and subjected to blood ultrafiltration to restore satisfactory circulatory parameters. No patient underwent cardiac catheterization; all patients were operated upon on the basis of echocardiographic data alone. One patient (4%) died during hospitalization; two (8%) died later at 48 and 12 months after the first intervention. The reoperation rate was 12%. After a mean follow-up of 49 (range 1-71) months, 21 of the survivors (95%) were in New York Heart Association functional class I or II; the actuarial 5-year survival rate was 87%. Precise preoperative assessment of early operative indications and timely association of medical therapy in unstable patients could represent a step forward in the treatment of acute infective endocarditis.

Adolescent↗