Biomedical subjects
Publications and source records attributed to Giuseppe Rescigno.
We report a case of delayed detachment of the right coronary cusp, occurring 12 days after a motorcycle crash. Echocardiographic findings mimicked a type I De Bakey aortic dissection. A brief discussion of cause, evolution, diagnosis, and treatment is included.
OBJECTIVES: Surgical ventricular reverse remodeling has been shown to possibly improve hemodynamics and symptoms, but effects on long-term mortality are not established. No consistent data are available on which patients will benefit most from this procedure. This study was designed to analyze the predictors of long-term survival after surgical ventricular reverse remodeling in patients with ischemic cardiomyopathy. METHODS: Eighty-five patients who underwent surgical ventricular reverse remodeling between May 1991 and October 2003 were retrospectively analyzed. Left ventricular wall motion and left ventricular equatorial diameter were assessed by means of angioventriculography. Left ventricular ejection fraction and volumes were measured by means of echocardiography. Cox regression analysis was used in several combinations to create a final model for identifying predictors of death. RESULTS: Actuarial survival after 1, 3, 5, and 10 years was 89%, 79%, 75%, and 75%, respectively. New York Heart Association class improved from 2.9 +/- 1.0 to 1.3 +/- 0.5 (P < .0001), left ventricular ejection fraction increased from 27.6% +/- 6.3% to 43.0% +/- 10.1% (P < .0001), and left ventricular end-systolic volume index decreased from 89.6 +/- 27.6 mL/m2 to 56.5 +/- 34.5 mL/m2 (P < .0001). Multivariate analysis identified left ventricular equatorial diameter of 70 mm or greater (hazard ratio, 5.28; 95% confidence interval, 1.79-11.71; P = .020) and segmental akinesia (hazard ratio, 4.46; 95% confidence interval, 1.23-17.12; P = .024) as the only independent predictors of death. CONCLUSIONS: In this analysis of a single cohort of patients, surgical ventricular reverse remodeling improves the symptoms of ischemic cardiomyopathy, as well as left ventricular function, shape, and volume, with encouraging long-term outcomes, particularly in patients with dyskinesia. A left ventricular equatorial diameter of 70 mm or greater appears to be an important independent prognostic factor, which suggests the relevance of the left ventricular equatorial region for effective surgical reverse remodeling.
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A rare case of systolic anterior motion (SAM) after mitral valve repair is described. A temporary postoperative left ventricular (LV) dysfunction protected against this complication during the early postoperative period. Only on day 9 postoperatively did the left ventricle recover and SAM develop, with significant obstruction of the LV outflow tract. Subsequently, mitral valve replacement was required. This case demonstrates the importance of the LV geometrical relationships that predispose to this complication.
Despite current low overall perioperative mortality, ischemic complications due to coronary artery translocation remain the most unwanted early complication of the arterial switch operation. We describe the case of a boy who underwent, at five days of age, one-stage arterial switch operation for transposition of the great arteries with repair of ventricular septal defect and coarctation of the aorta. Early postoperative course was complicated by severe ischemic left ventricle (LV) dysfunction and development of a ventricular septal aneurysm. At four years of age he underwent successful surgical ventricular restoration associated with implantation of a biventricular pacing, with complete resolution of heart failure symptoms.
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Takayasu's arteritis (TA) is a chronic large vessel vasculitis, first described in 1908 by the Japanese ophthalmologist Takayasu, affecting more frequently young women. The typical lesions represented by aneurysmatic dilatation or obliteration, and narrowing of the arterial lumen may pose technical difficulties as well as demanding decision making for treatment. Since Jarvell first described aortic regurgitation in TA in 1954, unresolved problems still remain for aortic valve replacement, particularly because of the young age of these patients. We report the case of a 28-year-old woman, with a known history of TA, referred to our department.
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Porcelain aorta represents a serious condition for coronary artery bypass graft operations. Here we describe a simple technique to avoid any aortic manipulation during an off-pump coronary artery bypass graft procedure. The right internal thoracic artery is used as the source of blood inflow for single or sequential venous grafts. We have used this technique with good results in 5 elderly patients with eggshell aorta.
To reduce the time needed for clamping or circulatory arrest (or both) during substitution of a prosthesis for the thoracic aorta, we developed an expandable device that can be used with any commercially available prosthetic graft to enable sutureless aortic anastomosis. Improvements upon a previous version of the device include the use of nickel-titanium alloy (Nitinol) instead of stainless steel. This, together with an improved wire-looping design, now enables continuous control of diameter, even when the device is in contact with blood. A further improvement consists of 4 metallic hooks on the outer surface, which enable firm fixation to the aortic stump. In March 2001, a 47-year-old man was admitted to our institution for evaluation of left upper-lobe bronchogenic adenocarcinoma that had infiltrated the distal aortic arch and upper descending aorta. Re-staging of the neoplasm ruled out distant metastasis. We resected the infiltrated aortic wall en bloc with the upper lobe. The expandable device enabled the distal anastomosis of the aortic prosthesis to be performed easily, in less than 3 minutes. The main advantages of this device are an easier, quicker anastomosis and the absolute prevention of suture-line hemorrhage (no suture line). The expandable device overcomes the drawbacks of the intraluminal ringed prosthesis used in the past.
Postoperative pain control still represents a major challenge in every surgical field. Bupivacaine wound infiltration is frequently used to reduce the pain related to the surgical incision itself. In this randomized study, we investigated the efficacy of bupivacaine local anesthesia after median sternotomy to reduce postoperative pain. Forty-seven patients undergoing major cardiac surgery procedures were allocated randomly to group A (bupivacaine wound infiltration 0.5%; 10 mL, followed by continuous infusion: 10 mg/24 H) or to group C (controls). Extubation time, postoperative arterial blood gases, postoperative pain (assessed by means of a visual analog scale), and morphine consumption were the endpoints of the study. Patients of group C were extubated earlier; blood gases and VAS values were similar in both group. Bupivacaine local analgesia did not improve postoperative pain control after median sternotomy.