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Biomedical subjects

G Possati

Publications and source records attributed to G Possati.

At least 37 records · Page 2Linked to original sources
PubMed1999

[The radial artery in coronary surgery: the midterm clinical and angiographic results and the variation in vasoreactivity over time].

OBJECTIVE: To evaluate the mid-term angiographic results of radial artery grafts used for myocardial revascularization. METHODS: The first 68 consecutive surviving patients who received a radial artery graft proximally anastomosed to the aorta at our institution were restudied in a five-year follow-up (mean 59 +/- 6.5 months); 48 of these patients had already undergone an early angiographic examination. The response of the radial artery to the endovascular infusion of serotonin was evaluated one and five years after surgery and the mid-term status of the radial artery grafts was correlated with the degree of stenosis of the target vessel and with the Ca(++)-channel-blocker therapy. RESULTS: The patency and perfect patency rates of the radial artery five years after the operation were 91.9 and 87.0% respectively. All radial artery grafts that were patent early after surgery remained patent at mid-term follow-up and in seven patients early parietal irregularities disappeared after five years. The early propensity to graft spasm after serotonin challenge decreased markedly at mid-term follow-up. The continued use of Ca(++)-antagonists after the first postoperative year did not affect the status of the radial artery graft, whereas the severity of target-vessel stenosis markedly influenced the angiographic results. CONCLUSIONS: The mid-term angiographic results of RA grafts used for myocardial revascularization are excellent. A correct surgical indication is essential, whereas continued therapy with Ca(++)-antagonists after the first year does not influence the mid-term angiographic results.

Aged↗
PubMed1999

Stenting of a stenotic radial artery coronary graft: a new therapeutic scenario in coronary artery disease.

With the increasing application of arterial coronary revascularization, a number of patients may develop arterial graft obstructive disease. In addition, the predominantly muscular structure of the radial artery wall may predispose radial artery coronary grafts to spasm. For the first time, we describe a case of stenting of a stenotic free radial artery graft and discuss the technical and pathophysiological aspects of the procedure.

Angioplasty, Balloon, Coronary↗
PubMed1999

Perioperative management of a patient with Werlhof disease undergoing myocardial revascularization.

We herein report the case of a patient with idiopathic thrombocytopenic purpura (Werlhof disease) and coronary artery disease undergoing myocardial revascularization. The use of monomeric immunoglobulins, corticosteroids, platelets transfusion, use of a cell saver, normothermic cardiopulmonary bypass, aprotinine and homologous blood transfusion were combined in order to minimize the risk of bleeding complications in the postoperative period.

Aged↗
PubMed1999

[Remodelling of the radial artery graft 5 years after aortocoronary bypass intervention].

BACKGROUND: The radial artery (RA) is being employed as coronary artery bypass graft with good results, but when it is proximally anastomosed to the ascending aorta, undergoes substantial hemodynamic changes which could lead to significant graft intimal hyperplasia. The aim of this study was to investigate the evolution of RA graft morphology over time. METHODS: We studied 20 patients with a perfectly patent RA graft at both 1 and 5 year angiography after coronary artery bypass graft. RESULTS: Both RA graft and grafted coronary artery diameters, assessed by quantitative coronary angiography, significantly increased at 5 years, in comparison to 1 year angiography (2.08 +/- 0.45 vs 2.54 +/- 0.53 mm, +22%, p < 0.001 and 1.92 +/- 0.47 vs 2.18 +/- 0.41 mm, +13.3%, p < 0.001, respectively). CONCLUSIONS: Hemodynamic changes following RA employment for coronary artery bypass graft stimulate a remodeling of RA graft itself and of the grafted coronary arteries. The progressive increase of diameters observed in RA grafts strongly argues against the development of flow-limiting graft intimal hyperplasia when RA is proximally anastomosed to the ascending aorta. Moreover, grafted coronary artery dilation suggests that hemorrheologic changes following coronary artery bypass graft could play a major role in the development of RA remodeling over time.

Analysis of Variance↗
PubMed1999

Internal mammary artery grafts and competitive flow. Controversies persist.

We report one case in which chronic native competitive flow from an almost normal target coronary artery did not influence IMA graft patency. This patient underwent control postoperative angiography 11 months after surgery and the mammary artery-left anterior descending graft was found to be normofunctioning despite the fact that the coronary artery showed no residual stenosis.

Coronary Angiography↗
PubMed1998

Steal phenomenon from mammary side branches: when does it occur?

BACKGROUND: The hemodynamic significance of patent mammary graft side branches is still controversial. This study was designed to evaluate the potential for flow steal of patent mammary side branches in different hemodynamic conditions. METHODS: Echo-Doppler measurement of mammary graft flow was performed at rest and after dipyridamole-induced coronary vasodilatation in 10 patients with angiographic demonstration of evident mammary graft side branches (study group) and in 10 matched control patients (control group). Concomitant thallium-201 myocardial scintigraphy was performed to assess the adequacy of mammary flow to the myocardial oxygen demand. Patients of the study group were also submitted to flow evaluation in condition of selective muscular or combined systemic and coronary relaxation. RESULTS: No difference in mammary flow and adequacy to myocardial oxygen demand was detected between patients of the study and control groups both at rest and after dipyridamole infusion. In patients with patent side branches the systolic-to-diastolic flow ratio was maintained in case of combined coronary and peripheral vasodilatation, whereas selective muscular relaxation led to an increase in the systolic and a reduction in the diastolic flow. CONCLUSIONS: Flow steal from patent mammary graft side branches is possible only in case of selective muscular vasodilatation. As this situation is unlikely to occur in the clinical setting, the potential for flow steal of mammary side branches in cardiac surgery patients seems to be minimal.

Case-Control Studies↗
PubMed1998

Midterm clinical and angiographic results of radial artery grafts used for myocardial revascularization.

OBJECTIVE: To evaluate the midterm angiographic results of the use of radial artery grafts for myocardial revascularization. METHODS: The first 68 consecutive surviving patients who received a radial artery graft proximally anastomosed to the aorta at our institution were studied again at 5 years (mean 59 +/- 6.5 months) of follow-up; 48 of these patients had previously undergone an early angiographic examination. The response of the radial artery to the endovascular infusion of serotonin was evaluated 1 and 5 years after the operation, and the midterm status of the radial artery graft was correlated with the degree of preoperative stenosis of the target vessel and with calcium-channel blocker therapy. RESULTS: The patency and perfect patency rates of the radial artery grafts 5 years after the operation were 91.9% and 87.0%, respectively. All radial artery grafts that were patent early after the operation remained patent at midterm follow-up, and early parietal irregularities in 7 patients were seen to have disappeared after 5 years. The early propensity toward graft spasm after serotonin challenge was markedly decreased at midterm follow-up. The continued use of calcium-channel antagonists after the first postoperative year did not influence the radial artery graft status, whereas the preoperative severity of the target-vessel stenosis markedly influenced the angiographic results. CONCLUSIONS: The midterm angiographic results of radial artery grafts used for myocardial revascularization are excellent. The correct surgical indication is essential. Continued therapy with calcium-channel antagonists after the first year does not influence the midterm angiographic results.

Calcium Channel Blockers↗
PubMed1998

Systematic clinical and angiographic follow-up of patients undergoing minimally invasive coronary artery bypass.

OBJECTIVE: We herein analyze the results of the systematic clinical and angiographic control performed in a series of 77 consecutive patients undergoing minimally invasive coronary artery bypass. METHODS AND RESULTS: From January 1995 to June 1997, 77 patients underwent minimally invasive coronary artery bypass at our institution. There was one inhospital death, one noncardiac late death, and five patients had to be reoperated for graft malfunction. A total of 76 patients underwent postoperative angiographic follow-up. In 66 cases (86.8%) the thoracic artery graft, the target vessel, and the anastomosis were patent and functioning normally. In one case the graft was occluded. In the remaining nine cases the thoracic artery graft was patent but with major anomalies of either the anastomosis, the target vessel, or the course of the thoracic artery. Patients operated using especially designed instruments had angiographic results clearly superior to those of patients operated using conventional instrumentation (perfect patency rate 100% vs 81.8%). At a mean follow-up of 18 months, 98.5% of the surviving patients are asymptomatic with negative myocardial scintigraphy. CONCLUSIONS: The perfect patency rate of minimally invasive revascularization performed without the use of dedicated instruments is unacceptably low. The use of specific devices is likely to result in a substantial improvement in the angiographic results.

Coronary Angiography↗
PubMed1998

Non-invasive evaluation of mammary artery flow reserve and adequacy to increased myocardial oxygen demand.

OBJECTIVE: To evaluate the flow reserve and adequacy to meet myocardial requests in stress conditions of mammary artery-left anterior descending (IMA-LAD) grafts using a non-invasive method. METHODS: Patients (20) with angiographic evidence of normofunctioning left IMA-LAD grafts were submitted to dypiridamole Tl201 myocardial scintigraphy and concomitant transthoracic echo-doppler evaluation of the IMA flow at a mean interval of 32.5 months after surgery. RESULTS: Under basal conditions, the mean peak and end flow velocities in systole were 0.39 and 0.06 m/s, respectively. In diastole, the mean peak and end flow velocities were 0.27 and 0.02 m/s and mean tele-diastolic flow velocity was 0.14 m/s, with a mean systolic/diastolic ratio of 1.51. After dypiridamole infusion, mean systolic velocities were 0.47 (peak) and 0.23 (end) m/s, respectively + 20 and + 283%, whereas mean diastolic velocities were 0.56 (peak) and 0.06 (end) m/s, +107 and +200%, respectively. Mean tele-diastolic flow velocity increased to 0.32 m/s (+128%) and the systolic-diastolic index changed to 0.85. In all cases no significant scintigraphic evidence of induced ischemia was demonstrated in the LAD region. CONCLUSIONS: Transthoracic echo-doppler evaluation combined with Tl201 myocardial scintigraphy is a useful tool for the assessment of IMA flow reserve and adequacy to stress conditions. In the late postoperative period, the IMA shows the possibility of increasing the flow velocity, almost 2-fold; the increase in flow is prevalently diastolic and leads to a complete reversal of the physiological systolic/diastolic flow ratio. The flow reserve of IMA is always able to meet the augmented myocardial oxygen demand after dypiridamole infusion.

Aged↗
PubMed1998

Integrated approach for revascularization in multivessel coronary artery disease and porcelain aorta.

We report two cases in which combined beating heart revascularization of the left anterior descending artery (LAD) and percutaneous angioplasty of the non-LAD target arteries were adopted after the intraoperative detection of porcelain aorta and impossibility to complete surgical revascularization. This type of strategy preserves the benefits of surgical LAD grafting and complete revascularization and results in a simple and low-risk technical procedure in an otherwise challenging setting.

Aged↗
PubMed1998

Tepid systemic perfusion and intermittent isothermic blood cardioplegia in coronary surgery.

BACKGROUND: To evaluate the safety and effectiveness of tepid perfusion and isothermic blood cardioplegia in coronary surgery. METHODS: We studied 200 patients undergoing myocardial revascularization: 100 procedures were performed with moderate systemic hypothermia (28 degrees C) and cold crystalloid cardioplegia (4 degrees C); the other 100 patients received tepid systemic perfusion (TP) (34 degrees C) and intermittent blood cardioplegia at the same temperature according to the minicardioplegia technique (Group 2). The two groups were comparable with regards to age, extent of disease, preoperative left ventricular function and extra-corporeal circulation (ECC) time. RESULTS: In the tepid group we observed a higher incidence of spontaneous resumption of cardiac rhythm at cross-clamp removal compared to the hypothermic group (93% vs 34%; p<0.001). No difference was found in cardiac index at specified intervals, myocardial enzymes, inotrope requirements, arrhythmias, need for vasopressors and postoperative blood loss. Fluid balance at the end of ECC was significantly lower in the tepid group (343+/-635 ml vs 883+/-925 ml; p<0.001). Hospital mortality and morbidity were the same in the two groups. CONCLUSIONS: Our data suggest that TP and isothermic blood cardioplegia represent a simple, safe and effective method of systemic and myocardial protection which may be an alternative to traditional hypothermia.

Aged↗
PubMed1997

Palliative coronary artery surgery in patients with severe noncardiac diseases.

Eight patients with severe systemic pathologies and refractory angina unsuitable for angioplasty were submitted to palliative surgical revascularization without the use of cardiopulmonary bypass and limited to the culprit vessels. Complete relief from angina was achieved in all patients without postoperative mortality and morbidity.

Aged↗
PubMed1997

The internal mammary artery malperfusion syndrome: late angiographic verification.

BACKGROUND: Here we report our experience with the incidence and the surgical treatment of the internal mammary artery (IMA) malperfusion syndrome, evaluate the predictive role of previously described risk factors for the syndrome, and assess the late patency of IMA grafts in patients in whom an IMA malperfusion syndrome was diagnosed and treated by additional saphenous vein grafting of the left anterior descending coronary artery. METHODS: From June 1992 to November 1995, 969 IMAs were anastomosed to the left anterior descending coronary artery system. In 11 patients, IMA malperfusion syndrome was diagnosed and treated by additional saphenous vein grafting of the LAD. There were 8 men and 3 women with a mean age of 58.9 years. The angiographic and clinical data for each patient were reviewed, and all but 1 surviving patient underwent late angiographic control (mean follow-up, 18 months; range, 4 to 46 months). RESULTS: One patient died in the hospital. No previously described risk factor was strongly associated with the occurrence of IMA malperfusion syndrome. Late angiography revealed a malfunctioning IMA graft in 7 of the 9 patients. A string sign was observed in 1 patient and a normally functioning IMA anastomosed to a diagonal branch not connected to the LAD, in another. In no patient was a widely patent and normally functioning IMA graft observed. CONCLUSIONS: In our series, a high proportion of IMA grafts were found to be malfunctioning at late angiography. This observation, in contrast to previous reports, suggests that IMA malperfusion syndrome can often be attributable to technical problems in harvesting the IMA or in performing the IMA anastomosis. Functional IMA insufficiency seems to play only a marginal role in determining the IMA malperfusion syndrome.

Coronary Angiography↗
PubMed1997

Conventional left atrial versus superior septal approach for mitral valve replacement.

BACKGROUND: This study was designed to evaluate the safety and effectiveness of the superior septal approach for routine mitral valve replacement. METHODS: One hundred forty-six consecutive patients undergoing mitral valve replacement at our institution were randomly assigned to undergo the procedure using either the conventional left atriotomy or the superior septal approach. Postoperatively and during the follow-up, 12-lead electrocardiography, 24-hour Holter monitoring, and transthoracic and transesophageal echocardiography were performed in all patients. RESULTS: The cardiopulmonary bypass and cross-clamp times were significantly higher in the superior septal group. No significant difference in blood loss was found between the two groups, and no residual atrial septal defect was found in patients in whom we used the superior septal approach. The maintainance of sinus rhythm at late follow-up and the incidences of postoperative arrhythmias and newly developed atrioventricular block were not significantly different between the two groups. CONCLUSIONS: The use of the superior septal approach to the mitral valve is not associated with a greater incidence of rhythm disturbances or other complications. Because this approach provides optimal exposure of the valve and the subvalvular apparatus, it has been routinely adopted for use in patients undergoing mitral valve replacement at our institution.

Adult↗
PubMed1997

Unusual right coronary artery anomaly with major implication during cardiac operations.

We report a case in which an unrevealed high origin of the right coronary artery (almost 4 cm above the left coronary sinus) led to major complications during a routine atrial septal defect closure. We stress that, in absence of preoperative coronary angiography, coronary artery anomalies should always be considered and minimal ascending aorta manipulation and antegrade/ retrograde myocardial protection should be recommended.

Adolescent↗