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Biomedical subjects

L A Iannone

Publications and source records attributed to L A Iannone.

At least 19 recordsLinked to original sources
PubMed1992

Benefits of combined balloon pumping and percutaneous cardiopulmonary bypass.

Sixteen patients (2 women, 14 men) aged 29 to 72 years with continued cardiogenic shock during intraaortic balloon pumping (IABP) had additional treatment with percutaneous cardiopulmonary bypass (PBY). Cause of cardiogenic shock was myocardial infarction in 7 (3 survived), failed percutaneous transluminal coronary angioplasty requiring emergency coronary artery bypass grafting in 5, postoperative aortic valve replacement in 1, postoperative emergency coronary artery bypass grafting in 1, after cardiac transplantation in 1, and bridging to transplantation in 1. Mean blood pressure with PBY and IABP combined was 75 mm Hg versus 60 mm Hg with IABP off. Percutaneous cardiopulmonary bypass flows ranged from 0.8 to 2.1 L/min with a mean flow of 1.3 L/min. Time on IABP ranged from 24 hours to 1 week. Time on IABP to PBY ranged from 1 to 20 hours, and time on PBY ranged from 65 minutes to 20 hours. Ten of 16 (63%) were successfully weaned, and 3 died after weaning. Seven of 16 (44%) survive. Combined IABP with PBY appears to be a better therapy than either one individually. Staging the therapy as the balloon first in and last out appears to be a good methodology.

Adult↗
PubMed1992

Sheathless insertion of the percutaneous intraaortic balloon pump: an alternate method.

A technique is described that allows insertion of a standard percutaneous intraaortic balloon without use of the larger 12F sheath. Standard 9.5-cm. Percor balloons were inserted in a series of patients without using the provided sheath. Elimination of the sheath reduced the potential vascular complications related to the extra bulk placed in the femoral artery by the sheath. No serious complications were noted in more than 25 patients.

Humans↗
PubMed1991

Takayasu's disease with axillary, right coronary artery, and right internal mammary stenosis treated with angioplasty.

A 47-year-old woman presented with progressive angina and failed medical therapy. After an unsuccessful attempt at angioplasty of a totally occluded right coronary artery, coronary artery bypass using the right internal mammary artery was performed. She presented 2 years later with stenosis in the mammary graft, right coronary artery, and axillary artery. These lesions were all treated with angioplasty.

Angioplasty, Balloon↗
PubMed1989

Disrupted coronary artery caused by angioplasty: supportive and surgical considerations.

Of 2,859 patients having percutaneous transluminal coronary angioplasty, 201 (7%) underwent emergency coronary artery bypass grafting. Two categories of patients were reviewed. Group 1 consisted of 126 patients of 2,304 who had immediate coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty. Ninety-eight of these patients had angiographic evidence of occlusion of a coronary artery, and 28 had angiographic evidence of coronary artery dissection. Epicardial hemorrhage was observed at operation in 20% (25 patients). Three deaths (2.4%) occurred in group 1, and an average of 3.3 grafts was performed per patient. Group 2 comprised 75 of 555 patients who had unsuccessful attempted percutaneous transluminal coronary angioplasty during an evolving myocardial infarction and required immediate coronary artery bypass grafting. Angiography revealed coronary artery occlusion in 61 patients with dissection in 14. All group 2 patients had evidence of myocardial injury by electrocardiographic and enzymatic (myocardial-specific isoenzyme of creatine kinase) criteria. Three deaths (4%) occurred in this group, and there was an average of 3.4 grafts per patient. Percutaneous transluminal coronary angioplasty is routinely performed without surgical consultation, although an operating room and team are usually available. Supportive techniques include the intraaortic balloon pump and percutaneous cardiopulmonary bypass. In those patients with coronary artery dissection, care must be taken to reestablish the true lumen of the coronary artery. Hemopericardium should be surgically explored and broken guidewires or other foreign bodies or debris removed. From 1979 through 1986, the number of patients requiring emergency coronary artery bypass grafting after percutaneous transluminal coronary angioplasty steadily declined to less than 5%.

Angioplasty, Balloon↗
PubMed1989

Percutaneous cardiopulmonary bypass: application and indication for use.

Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB. One patient requiring a very difficult proposed angioplasty received percutaneous CPB support while triple-vessel angioplasty was performed. Percutaneous CPB appears to be beneficial in resuscitating patients with refractory cardiac arrest or other forms of circulatory collapse except trauma. Limited use for brief periods in high-risk patients having elective angioplasty might be applicable.

Angioplasty, Balloon↗
PubMed1988

Internal mammary artery versus saphenous vein graft to the left anterior descending coronary artery: prospective randomized study with 10-year follow-up.

In 1975, 80 patients undergoing revascularization were prospectively randomized to receive either a greater saphenous vein (SV) graft (41 patients, Group 1) or a left internal mammary artery (LIMA) graft (39 patients, Group 2) to the left anterior descending coronary artery (LAD). All patients were completely revascularized. The average number of grafts per patient in both groups was 3.2. Patients were followed 10 years; follow-up was 97.5% complete. Group 1 and Group 2 were compared in regard to mortality, treadmill response, myocardial infarction, reoperation, percutaneous transluminal coronary angioplasty, and return to work. Mortality in Group 1 was 17.9% versus 7.7% in Group 2 (p less than 0.05). Treadmill studies were positive in 17 Group 1 patients and 7 Group 2 patients (p less than 0.05). Myocardial infarctions occurred in 8 patients in Group 1 versus 3 in Group 2. The number of reoperations was 2 in Group 1 versus 1 in Group 2. Percutaneous transluminal coronary angioplasty was performed in 3 patients in Group 1 and 2 in Group 2. Repeat studies revealed 76.3% patency of the SV graft to the LAD (Group 1) and 94.6% patency of the LIMA graft to the LAD (Group 2). Cardiac-related mortality in Group 1 was 12.8% at 10 years (5 patients) versus 7.7% in Group 2 (3 patients). Based on this study, the IMA is a superior conduit for bypass to the LAD.

Adult↗
PubMed1983

Intravenous balloon pumping for acute right ventricular failure.

A patient with acute right ventricular failure and severe hemodynamic instability following coronary artery revascularization was treated with intra-aortic and intravenous balloon pumping. The intravenous balloon was timed to inflate during diastole and deflate during systole as did the intra-aortic balloon; in fact, the two were connected to the same system through a Y-connector. The intravenous balloon acted as an artificial atrium, which allowed approximately 20% improvement in the cardiac output when this intravenous balloon was functioning. Hemodynamic stability was achieved with this system. Intravenous balloon pumping should be considered for patients with unstable hemodynamics secondary to acute right ventricular failure.

Aged↗
PubMed1982

Coronary artery spasm following coronary artery revascularization.

Coronary artery spasm is a well-documented phenomenon in patients undergoing medial treatment. We describe coronary artery spasm occurring in the immediate postoperative period following coronary artery bypass operation. The spasm occurred in a vessel that was not operated on and that had no apparent lesion. The diagnosis of spasm was made by coronary angiography immediately after operation. Complications associated with this spasm are discussed. Emphasis is placed on early postoperative angiography for patients whose condition is inexplicably unstable after operation.

Amyl Nitrite↗
PubMed1979

Anoxic hypothermic cardioplegia compared to intermittent anoxic fibrillatory cardiac arrest. Clinical and metabolic experience with 1080 patients.

Appropriately applied, hypothermic cardioplegia allows an excellent surgical setting that can significantly reduce the myocardial ischemic injury resulting from anoxia. One thousand eighty adult and pediatric patients underwent a variety of corrective cardial surgical procedures utilizing cold potassium cardioplegic solution injected into the coronary arteries via the aortic root. Myocardial septal temperature was maintained at 18--20 degrees during arrested time. This group of patients was compared to a group of 220 patients that underwent intermittent normothermic ischemic arrest to perform cardiac surgical procedures. Significant reduction in morbidity, mortality, perioperative myocardial infarction was noted in favor of the cardioplegic group. Metabolic coronary sinus blood analysis in the group undergoing surgery with cardioplegia revealed favorable changes in myocardial lactate and oxygen extraction.

Adult↗