Biomedical subjects

J Caliani

Publications and source records attributed to J Caliani.

7 recordsLinked to original sources

PubMed1997

The stentless Bravo 300 aortic porcine xenograft: supra-annular versus annular implantation.

The aim of the study was to compare the supra-annular and intra-annular implantation techniques by evaluating the differences in early haemodynamic outcome (gradients, effective orifice area, regurgitation). Since August 1991, 200 stentless Bravo model 300 valves have been implanted. Patients were divided into three groups of consecutive cases: group 1 (n = 50) represents exclusively intra-annular implantation; group 2 (n = 50) is a transitional period: and group 3 (n = 100) comprises only patients with supra-annular implantation. Significant differences were found (P<0.001) in low postoperative gradients (mean < or = 10 mmHg): 24% in group 1, 42% in group 2, and 95% in group 3. Comparing groups 1 and 3, gradients were lower and effective orifice area was augmented in all valve sizes in group 3. Trivial central regurgitation was present in groups 1-3 (6%, 12% and 0% respectively). Peripheral regurgitation was trivial in 6%, 8% and 0% and mild to moderate in 4%, 2% and 0% (P<0.001).

Animals↗

PubMed1996

Mitral valve repairs using the posterior tricuspid leaflet and chordae. Technique and results.

OBJECTIVE: Some mitral lesions are still out of reach of conventional repairs. Transferring the posterior leaflet of the tricuspid valve with its subvalvular apparatus to the mitral valve is a new autograft technique which has allowed us a conservative approach in cases where repair seemed less predictable. METHODS: After removing the posterior tricuspid leaflet with its subvalvular apparatus, the tricuspid autograft was inserted by implanting its papillary muscle onto the mitral papillary muscle and then by suturing the leaflet tissue in place. The tricuspid valve was subsequently repaired by annular plication and leaflet suture. A tricuspid ring was used in all but the first case. RESULTS: The age of the seven patients ranged from 20 to 70 years. Postoperative controls by transesophageal echocardiography showed no leaks in five and trivial in one on the site of the mitral repair. On the tricuspid valve, we found a moderate leak in the first case and trivial or none in the following cases, where a tricuspid ring was used. With a 3-12 month follow-up the results are stable. CONCLUSIONS: This autograft technique is reproducible, and extends the field of mitral valve repairs. Compared to segments of mitral homografts, we prefer the intraoperative availability of natural chordae and valvular leaflet that have no immunological interference. The patient is his own tissue bank and the tricuspid valve can be repaired with a very low risk of significant dysfunction.

Adult↗

PubMed1996

[Mitral valve repair by transfer of the posterior tricuspid leaflet and its chordae].

Mitral valve repair was performed in six patients by transferring the posterior tricuspid leaflet with its sub-valvular apparatus onto the mitral valve. This new technique considers the tricuspid valve as the patients own tissue bank where the posterior leaflet and eventually the adjacent part of the anterior leaflet is used as a "donor" valve, based on the knowledge that the right atrio-ventricular valve can be efficiently repaired with a very low risk of significant dysfunction. The mitral repair consists of incorporating the tricuspid autograft by securing the tricuspid papillary muscle to the mitral papillary muscle and by suturing the leaflet tissue where required. A mitral annuloplasty ring reinforces the repair. The tricuspid valve is subsequently repaired by annular plication and leaflet suture. A tricuspid ring is necessary to maintain efficient remodeling. The six patients ages ranged from 20 to 70 years. A etiology, was rheumatic in the first case and degenerative in the following. In three cases, sterilised endocarditis was responsible for ruptured chordae and leaflet destruction. The mitral insufficiency was located in a commissural area in 4 cases, and was due to a widespread posterior prolapse in 2. Post-operative control transesophageal echocardiography confirmed the excellent results of the repair and proved that, in selected cases, the tricuspid leaflet inserted onto the mitral apparatus is very efficient in correcting mitral insufficiency, without causing significant tricuspid impairment. With a 3 to 7 month follow-up, the results are stable.

Adult↗

PubMed1996

[Repair of post-infarction left ventricular wall ruptures by biological glue and a flap from the pericardium. Results from 2 to 10 years].

The authors report their experience with a simple and efficient technique for repair of left ventricular free wall rupture complicating myocardial infarction. The technique consists, with the aid of cardiopulmonary bypass, in suturing a plaque of the patients own pericardium (6 to 8 cm in diameter) to the more normal tissue encircling the pathologic myocardium, and by injecting five ml of human fibrin glue as a cement under the pericardium to reinforce the remair and prevent leaking throughout the suture line. With a 10 year follow-up, we are able to be confident with the long term results. The five patients, at the time of operation were aged 46 to 74 years. The post-operative results and the annual echocardiographic controls have proved the technique to be sound without recurrences and without late complications such as pseudo aneurysms at the site of the repair.

Aged↗

PubMed1989

[Subaortic fibromuscular tunnel following resection of accessory mitral tissue. Surgical treatment].

When accessory mitral valve tissue obstructs the left ventricular outflow tract resection is considered a sufficient and definitive procedure. We report the unusual case of a child who had undergone such resection at the age of 4 years and who developed, over a few years, a recurrent subvalvular aortic obstacle consisting, this time, in a fibromuscular tunnel. In a second operation performed at the age of 12, a septal patch was inserted to widen the subaortic channel which was approached through a trans-septal infundibular route. Control examination showed a satisfactory pressure gradient and a sinus rhythm.

Child, Preschool↗

PubMed1987

[The autologous pericardial tube-flap. A new technic for restoring the continuity between the right ventricle and the pulmonary artery].

Re-establishing continuity between the right ventricle and the division of the pulmonary trunk may prove difficult in surgical correction of transposition of the great vessels. Although prosthetic tubes, which had many drawbacks, have been replaced by direct anastomoses, partial reconstruction of the pulmonary arterial wall is still often necessary. The materials commonly used are segments of gore-tex, stored pericardium and fresh or glutaraldehyde-treated pericardium. However, retractions may develop in these reconstructions resulting in pulmonary stenosis. These complications have revived the debate on the best technique for re-establishing continuity, and it is mandatory to use a growing tissue to keep pace with the child's development. We report here an original technique used in an infant. Previous studies have shown that the autologous pericardial flap, transformed here into a tube, retains its potential for growth.

Blood Vessel Prosthesis↗

PubMed1986

[Mitral stenosis with notable or important subvalvular changes. Complete open commissurotomies supported by chorda transfer].

Since 1983, 40 consecutive patients with mitral stenosis (MS) and significant disease of the subvalvular apparatus underwent open heart mitral commissurotomy (OHMC). The aim of the study was to evaluate the effects of an unrestricted dilatation of the two commissures followed by repair of the subsequent mitral regurgitation. The mitral regurgitation created by this procedure in 24 cases was corrected by transferring 2 to 6 chordae tendinae to the free border of the anterior and/or posterior leaflet in the commissural region. A central regurgitant lesion due to lack of coaptation of the valvular surfaces was treated by annuloplasty with a Carpentier prosthesis in 12 cases. The subvalvular abnormalities were treated by the conventional techniques of fenestration, resection and division of the papillary muscles. Thirty of the 38 survivors had no residual murmur, and 6 had a short low intensity systolic murmur. The 2D echocardiographic study showed no residual stenosis. The residual systolic murmurs were evaluated by pulsed Doppler and corresponded to very localised regurgitation. This extensive operative technique gives very good immediate valvular results which, associated with an adequate subvalvular procedure, are considered to be an important prognostic factor.

Adolescent↗