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Biomedical subjects

Giuseppe Tarelli

Publications and source records attributed to Giuseppe Tarelli.

7 recordsLinked to original sources
PubMed2006

An unusual cause of pulmonary edema: acute rupture of noncoronary sinus of valsalva aneurysm into the left atrium.

We present the case of a patient admitted to hospital with pulmonary edema and atrial fibrillation. The transthoracic echocardiogram showed noncoronary sinus of Valsalva aneurysm ruptured into the left atrium, with a turbulent flow directed toward the left atrium floor and the pulmonary vein, which explained the clinical presentation. Echocardiography played a crucial role in identification of the cause and correct therapeutic approach.

Acute Disease↗
PubMed2006

[Surgical therapy of coronary artery disease in the Italian cardiac surgery centers].

BACKGROUND: We conducted a national survey on surgical therapy for coronary artery disease and its complications, with the aim to eventually identify differences in the processes of care adopted in the Italian cardiac surgery centers. METHODS: Eighty-seven Italian cardiac surgery units received a questionnaire about their general activity profile and the following interest areas: (a) surgical myocardial revascularization techniques; (b) ischemic mitral regurgitation treatment; (c) left ventricular reconstruction procedures; (d) mechanical circulatory support and heart transplantation in ischemic cardiomyopathy. RESULTS: Forty-one Centers (47.1%) returned a completely filled questionnaire. The analysis of the answers showed differences in the therapeutic approaches adopted in the various centers regarding: choice of surgical technique and grafts for myocardial revascularization; propensity to treat moderate ischemic mitral regurgitation in the setting of severe left ventricular dysfunction; propensity to treat extended myocardial scars; treatment options in ischemic cardiomyopathy with advanced heart failure. The specific center profile (volume of activity, availability of heart transplantation) seems to influence the choice among the different treatment options. CONCLUSIONS: This study may contribute to show and analyze existing differences in clinical practice between different centers. Diagnostic and therapeutic approaches (processes of care) should be frequently monitored in order to promptly single out critical areas necessitating review or further researches, to standardize decision making criteria, and to improve care appropriateness.

Aged↗
PubMed2005

Left ventricular support by axial flow pump: the echocardiographic approach to device malfunction.

Axial flow pumps have gained increased acceptance in recent years as a bridge to heart transplantation and, more recently, as destination therapy. As left ventricular (LV) assist device dysfunction will be increasingly prevalent, the aim of our work was to introduce an echocardiographic management protocol as a guide to recognize the causes of pump failure. In this article we describe the echocardiographic approach to 5 episodes of malfunction of an axial flow pump (DeBakey, MicroMed Technology Inc, Houston, Tex) in 4 patients: 4 episodes caused by thrombosis of LV assist device and one caused by abnormal increase of systemic vascular resistance. In our experience, echocardiography played a pivotal role in clinical management of LV assist device failure. It allowed us to: assess patency and position of inflow and outflow cannulae; research the source of thromboembolic material; assess adequate LV filling and unloading; and optimize right ventricular function, volume replacement therapy, and pharmacologic support.

Echocardiography↗
PubMed2004

[Comorbidity in surgical myocardial revascularization: risk factors or contraindications for surgery].

BACKGROUND: The worsening evolution of patients undergoing surgical myocardial revascularization makes it difficult the stratification of the preoperative mortality risk, a correct evaluation of results and the comparison of results of different centers. The aim of the study was to evaluate the prognostic weight of comorbidity in surgical myocardial revascularization. METHODS: We evaluated the characteristics of preoperative morbidity in 4999 patients who underwent surgical myocardial revascularization during four different periods (1979-1980, 1991-1992, 1994-1998, 1999-2002). We also evaluated the in-hospital results. RESULTS: By comparing the four different periods, an increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction was observed. Surgical mortality decreased to 2.3%. Multivariate analysis of the 1999-2002 period showed that only renal insufficiency was a risk factor for in-hospital mortality. CONCLUSIONS: Although the preoperative risk is higher, nowadays hospital mortality is reduced thanks to new cardiac-surgical techniques and approaches that increasing the capacity of controlling comorbidity in the pre-, intra- and postoperative course. For a correct decision-making process it is crucial to assess how much comorbidity may influence the long-term follow-up in these patients independently of surgical myocardial revascularization.

Aged↗
PubMed2004

Surgical treatment of acute myocardial infarction.

BACKGROUND: The role of surgical revascularization in the treatment of acute myocardial infarction (AMI) has changed considerably over the last 30 years along with improvement in intraoperative management and techniques of myocardial protection. The aim of this work was to analyze the long-term results of our experience of emergency myocardial surgical revascularization for AMI. METHODS: Between January 1986 and October 2003, 237 patients (85.3% males; mean age 59.6 +/- 9.6 years) underwent emergency coronary artery bypass graft for severe AMI. At admission 82 patients (34.6%) were in cardiogenic shock, while 124 patients (52.3%) presented major preoperative complications (acute pulmonary edema, mechanical ventilation, intra-aortic counterpulsation, cardiac arrest). Preoperative intra-aortic counterpulsation was performed in 125 patients (52.7%). The mean time interval between symptom onset and surgery was 9.4 hours. Three-vessel disease was detected in 107 patients (45%), with main left stenosis in 12.9%. RESULTS: There were overall 50 hospital deaths (21.1%). Amongst patients with major preoperative complications, mortality was 36.2% (45 cases out of 124); mortality for cardiogenic shock was 40.2% (33 patients out of 82). Survival of the first 140 patients undergoing operation and then discharged was 97.8% at 1 year and 79.6% at 5 years. The survival rate of the first 60 patients in cardiogenic shock operated on and then discharged is 98.8% at 1 year and 81.2% at 5 years. The ejection fraction in 102 echocardiographically controlled patients was 37.2 +/- 8.5% preoperatively and 44.0 +/- 10.1% at pre-discharge (p = 0.0001). CONCLUSIONS: Surgical revascularization for AMI, especially if complicated by cardiogenic shock, is a valid therapeutic option that carries a high periprocedural risk but that is balanced by a satisfactory late survival. A more precise patient's risk assessment at admission, improvement of surgical and myocardial protection techniques, extensive use of intra-aortic counterpulsation, and new circulatory support when needed, can improve outcomes and late survival.

Coronary Circulation↗