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Biomedical subjects

L Camilleri

Publications and source records attributed to L Camilleri.

At least 19 recordsLinked to original sources
PubMed2006

[Long-term MRI follow-up of aortic dissection in 56 patients: therapeutic impact].

PURPOSE: To retrospectively assess the value of MRI in long-term follow-up of aortic dissection (AD) and its impact on therapy. MATERIALS AND METHODS: Comparison of clinical progression and analysis of 215 MRI examinations performed on 56 patients in our center from 1991 to 2002. RESULTS: Twenty-six patients (46%) had AD complications: 14 (54%) were asymptomatic and eight (31%) had subsequent surgical repair (native aorta upstream prosthesis disease in three patients and aneurismal dilatation of false lumen in five cases). Of the eight patients with secondary surgery, five (63%) were clinically asymptomatic. The delay between initial dissection and secondary surgery was less than 5 years in five patients and exceeded 10 years in three cases. The remaining 30 patients (54%) had unmodified radiological findings after a mean follow-up of 3.5 years (6 months to 9 years). CONCLUSION: MRI depicted AD complications in long-term follow-up of sometimes asymptomatic patients, allowing for adaptation of surgical treatment in 26 cases (46%).

Adult↗
PubMed2001

[Treatment with aorto-iliac stents of acute lower limb ischemia in a patient complicating acute type B aortic dissection].

Treatment with aorto iliac endoprothesis of lower limb ischemia occuring in a patient with acute type B dissection. The mechanism was dynamic ischemia. The dissecting flap prolapsed into the iliac artery origin and narrowed the aortic true lumen above it, but without extension of the flap into the iliac artery lumen. After right iliac artery stenting, a relative left iliac artery ischemia by the shift of the dissection flap required stent implantation. Eight months later, the walking perimeter without pain was 1500m. The interest of endovascular techniques to treat visceral or lower limb ischemic complications in dissected aorta is discussed.

Aortic Dissection↗
PubMed2000

Coil embolization of a false aneurysm with aorto-cutaneous fistula after prosthetic graft replacement of the ascending aorta.

AIM: To report palliative embolization of a false aneurysm over the distal suture line of an ascending aorta graft replacement. MATERIAL AND METHOD: A 78-year-old male patient was admitted for increasing bleeding of a chronic Manubrium ulceration, 20 months after coronary artery bypass complicated by perioperative ascending aorta dissection requiring prosthetic graft replacement. One month later, he underwent epiploplasty for a mediastinitis followed by long-term antibiotic therapy. Five months later, he presented with a Manubrium ulceration of the sternotomy. Spiral computerized tomography (CT) and aortography revealed a 20 mm anterior peri-prosthetic false aneurysm with a wide neck. Advanced age, active mediastinitis and patient's objection led us to perform percutaneous occlusion according to the Moret remodeling technique while protecting the coils release with balloon catheter inflation. RESULTS: No post-operative complication was observed and at 1-year follow-up the patient was doing well with no recurrent bleeding. Magnetic resonance imaging (MRI) and spiral CT controls confirmed coils stability without any internal flow. CONCLUSION: Percutaneous coils embolization of a large false aneurysm in the ascending aorta can be a palliative treatment in a surgically unsuited patient.

Aged↗
PubMed2000

[Kidney cancers with supra-diaphragmatic invasion. Surgical treatment using extracorporal circulation with heart arrest].

STUDY AIM: The study aim was to report results of nephrectomy with resection of cavo atrial thrombus in 6 patients with a renal carcinoma and supra-diaphragmatic vena cava extension and to discuss limits of the surgical indications. PATIENTS AND METHOD: Six patients, five adults (mean age: 57 +/- 10 years) and a four-year old girl, were operated on for a renal cell carcinoma with supra-diaphragmatic vena cava extension. The venous extension was detected in all cases by abdominal ultrasonography. The superior extent of the thrombus was effectively visualized by CT scan in three cases, and by ultrasonography and magnetic resonance imaging in all cases. All the patients were operated on, using cardio-pulmonary bypass, without circulatory arrest, four in normothermia, two in moderate hypothermia at 28 degrees C. RESULTS: Hospital mortality was 0%. Average intensive care unit stay was 3.8 days. During the following period, all the patients developed metastatic disease. Mean survival rate of the five adult patients who had loco-regional invasion was 9.4 months (range: 6 to 19). The young girl underwent a wedge excision of two pulmonary metastases one year later and was still alive 7 years later. CONCLUSIONS: With cardio-pulmonary bypass, surgical resection of cavo-atrial thrombi may be performed with a low mortality and morbidity rate but late results were disappointing. Surgery should be limited to patients without loco-regional invasion or distant metastatic disease, and therefore accurate preoperative staging is mandatory.

Adult↗
PubMed1998

Extracellular K+ dependence of inward rectification kinetics in human left ventricular cardiomyocytes.

BACKGROUND: In human ventricular cells, the inwardly rectifying K+ current (IK1) is very similar to that of other mammalian species, but detailed knowledge about the K+-dependent distribution of open and blocked states during rectification and about the K+-dependent modulation of inactivation on hyperpolarization is currently lacking. METHODS AND RESULTS: We used the whole-cell patch-clamp technique to record IK1 in myocytes isolated from subendocardial layers of left ventricular septum from patients with nonfailing hearts with aortic stenosis and cardiac hypertrophy who were undergoing open-heart surgery. Outward currents were very small at voltages positive to the reversal potential but increased at high external [K+]. Chord conductance measurements and kinetic analyses allowed us to estimate the proportion of channels in the open state and of those showing either slow unblock or instantaneous unblock (the so-called slow or instantaneous "activation") on hyperpolarization: the distribution in the individual states was dependent on external [K+]. The proportion of channels unblocking slowly was greater than that of channels unblocking instantaneously on hyperpolarization from the plateau voltage range. Hence, because of the previously reported link between the presence of highly protonated blocking molecules and slow unblock kinetics, it is suggested that high cellular concentrations of spermine may account for the low outward current density recorded in these cells. The current decrease observed on extended hyperpolarization was significantly relieved by an increase in external [K+]. CONCLUSIONS: The pattern of IK1 current alterations observed in the present model of human ventricular hypertrophy might favor enhanced excitability and underlie ventricular arrhythmias, possibly via increased intracellular polyamine levels.

Action Potentials↗
PubMed1998

Cultured neonatal rat cardiomyocytes and 99mTc-sestamibi to assess the direct effects of cardioplegia.

The efficacy of cardioplegia in neonatal myocardial protection is still a matter of debate. 99mTc-sestamibi cellular accumulation reflects sarcolemmal and mitochondrial electrical gradients. It was used to monitor the direct effects of two cardioplegic solutions, modified St Thomas' Hospital and Bretschneider, on normoxic and metabolically-inhibited cultured cells. Cellular accumulation of 99mTc-sestamibi, expressed by the ratio between intra and extra cellular concentrations, was assessed in three different sets of neonatal rat cardiomyocytes. Cells were either treated with different concentrations of modified St Thomas' solution (50, 75, 100%), they were treated or recovering from a treatment with modified St Thomas and Bretschneider solutions at 50% concentrations, or were recovering from treatment with modified St Thomas' and Bretschneider solution at 50% concentrations mixed with metabolic inhibitors. Cardioplegia depressed the tracer accumulation in a concentration-dependent manner. This effect was independent of the type of cardioplegia (120-min uptake, as a percentage of control values, modified St Thomas' 68+/-12 and Bretschneider 59+/-7) and was rapidly reversible. Cardioplegia was unable to prevent the depression of tracer accumulation induced by metabolic inhibitors and even induced a deleterious effect (120-min uptake, as a percentage of control values, metabolic inhibitors 69+/-12, metabolic inhibitors + modified St Thomas 38+/-14, metabolic inhibitors + Bretschneider 43+/-6) during recovery after 30 min of metabolic inhibition. It was concluded that cardioplegia has an apparent detrimental effect on neonatal cardiomyocytes accumulation of 99mTc-sestamibi during recovery from an ischaemic-like insult.

Animals↗
PubMed1998

Bicarbon valve -- European multicenter clinical evaluation.

OBJECTIVE: Fifteen collaborating centers in eight countries present their pooled experience with the new Bicarbon bileaflet valve. METHODS: Between 4/90 and 4/96, 1351 patients, 806 males and 545 females, aged 10 to 83, mean 58.4 +/- 12.4, underwent valve implantation. OPERATIONS: aortic valve replacement (AVR), 726; mitral valve replacement (MVR), 475; double valve replacement (DVR), 150. Additional procedures: CABG, 211; TV repair, 64; other, 152. RESULTS: Mortality: 67 early (seven valve related) and 56 late (40 valve related). Valve thrombosis: six obstructive, three non-obstructive; embolism: nine major cerebral, 37 other. Major bleeding: 29. Hemolysis: two clinically significant. Non-structural dysfunction: 24 paravalvular leaks, one leaflet interference. No structural failure! Endocarditis: 24. Reoperation 48: 22 non-structural dysfunctions, 14 endocarditis, seven thrombosis and embolism, five other. Estimated 5-year freedom from valve-related deaths is 97.2% for AVR and 92.4% for MVR; 4-year freedom from valve related deaths for DVR is 90.5%. Mean calculated NYHA improvement is 1.24. CONCLUSIONS: The Bicarbon mechanical prosthesis is well designed, durable, has good hemodynamic features and an acceptably low incidence of complications.

Adolescent↗
PubMed1997

Validity of a model of cultured myocardial cells for assessment of cardioplegia.

Myocardial protection is usually studied in vitro on perfused heart preparations, but never directly on cultured cardiomyocytes. We evaluated a model of cultured newborn rat cardiomyocytes to study both the cytotoxicity and the protective effect against chemical hypoxia of three cardioplegic solutions (St Thomas' I, Bretschneider, St Thomas' II) under normothermic (37 degrees C) and hypothermic (4 degrees C) conditions. Cytotoxicity was evaluated in 50% and 100% concentrations of the cardioplegic solutions with incubation times from 90 to 360 min. Myocardial protection was studied in 50% cardioplegic solution with metabolic inhibitors. Immediate and late viabilities, after 24 h of recovery in the medium, were evaluated by simultaneous staining with fluorescein diacetate and propidium iodide. At 37 degrees C, the 50% concentration of the three cardioplegic solutions did not modify cell viability. At 37 degrees C, with 360 min of incubation, the 100% concentration of the St Thomas' I and Bretschneider solutions diminished immediate viability (mean +/- SD; medium 87% +/- 2%; St Thomas' I 58% +/- 5%; Bretschneider 37% +/- 8%; St Thomas' II 89% +/- 3%) as well as late viability (medium 69% +/- 2%; St Thomas' I 32% +/- 3%; Bretschneider 24% +/- 7%; St Thomas' II 65% +/- 4%). At 4 degrees C, immediate and late viabilities were unaffected by cardioplegic solutions. At 37 degrees C, after 360 min incubation time, metabolic inhibitors diminished immediate viability to 29% +/- 1% and late viability to zero. None of the three cardioplegic solutions used at 50% concentration prevented this effect. At 4 degrees C, immediate viability was not significantly affected by metabolic inhibitors (73% +/- 10%), but the use of Bretschneider cardioplegic solution seemed to be detrimental (53% +/- 9%). On the other hand, recovery phase after pretreatment with metabolic inhibitors with or without cardioplegic solutions for 360 min significantly diminished late viability (medium 63% +/- 7%; metabolic inhibitors 17% +/- 8%; St Thomas' I 17% +/- 6%; Bretschneider 8% +/- 6%; St Thomas' II 15% +/- 3%) and again cardioplegia was inefficient. In conclusion, in this in vitro model for the study of cardioplegic solutions, only pure concentrations of the St Thomas' I and Bretschneider solutions under normothermic conditions were cytotoxic. The well-known protective effects of hypothermia against ischemia and reperfusion injury were both reproduced. Therefore, and even though cardioplegia failed to have any protective effect, probably owing to a severe metabolic inhibition, this model may be useful for studying myocardial protection.

Animals↗
PubMed1997

Successful treatment of tetralogy of Fallot with pulmonary atresia using a pulmonary homograft.

A 13-year-old boy with tetralogy of Fallot and pulmonary atresia after a Waterston and Blalock-Taussig shunt underwent successful repair using a cryopreserved pulmonary homograft as a valved extracardiac conduit. Aortic transection gave a good operative field for pulmonary angioplasty and closure of the Waterston anastomosis. The cryopreserved pulmonary homograft provided excellent handling characteristics. The postoperative course was good, and postoperative echocardiography showed good function of the valved conduit.

Adolescent↗
PubMed1997

Doppler echocardiographic study of three different mechanical valves in the aortic position: the use of external nominal diameter indexed to body surface area.

BACKGROUND AND AIMS OF THE STUDY: Previous studies have demonstrated the benefit of indexing body surface area (BSA) with ventriculo-arterial orifice diameters (or calculated effective surface dynamics) and with nominal external diameters of valves in order to study hemodynamic profiles in vivo or determine the clinical influence of this parameter. This study analyzes the relationship between BSA and nominal external diameter of mechanical valves implanted in the aortic position. It also evaluates the potential interest of using these diameters indexed to BSA in an echo-Doppler study of valves. METHODS: During 1994, a prospective echo-Doppler study of three models of mechanical valves in the aortic position was carried out. RESULTS: The echo-Doppler parameters of the aortic St. Jude Medical, Sorin Bicarbon and Dideco Monostrut prostheses have been studied with regard to nominal external diameters and were found identical to published data. There were no significant differences in these parameters between the three valves. In 128 patients, prosthetic external diameters were evenly distributed heterogeneously with regard to BSA. Indexing of nominal external diameter with BSA appeared a more reliable reference to study different echo-Doppler parameters, minimizing the effect of cardiac output. CONCLUSION: The in vivo echo-Doppler determination at rest of valve hemodynamic profiles should be carried out with reference to the nominal external diameter indexed to the BSA.

Adult↗
PubMed1995

Systemic-pulmonary shunt with a right retroesophageal subclavian artery.

A 19-day-old child suffering from cyanosis due to tetralogy of Fallot was palliated by using his right retroesophageal subclavian artery. It was anastomosed side-to-side onto the ascending aorta and end-to-side onto the right pulmonary artery. The palliation obtained with this systemic-pulmonary shunt was satisfying. The right brachial vascular flow was normal.

Aorta↗
PubMed1995

Mitral annuloplasty with a flexible linear reducer.

Although the ideal technique is still controversial, mitral valve reconstruction for mitral insufficiency usually includes an annuloplasty. From August 1985 to June 1993, 126 cases of pure, acquired mitral insufficiency were repaired by means of a posterior annuloplasty. Whatever the etiology, all types of mitral insufficiency allowing a mitral reconstruction were included. The annuloplasty, performed with a flexible linear reducer, was associated with valvular (62%) and subvalvular (11%) repairs. An associated surgical procedure was necessary in 62% of the patients. Operative mortality was 2.4%, and follow-up (mean 29 months) was complete for all survivors. Five-year survival was 90%. Five-year complication-free rate for emboli was 91%. Only one patient at 12 months underwent reoperation to treat recurrent mitral insufficiency. Ninety-seven patients were in New York Heart Association Class I or II. Follow-up echocardiographic studies on 75% of eligible patients showed a free rate for significant regurgitation of 99%. Mean valve area was estimated at 2.88 +/- 0.85 cm2. These findings suggest that the flexible linear reducer seems to be a reliable device and a valid alternative for annuloplasty.

Adult↗
PubMed1995

[Congenital pulmonary arteriovenous fistula. Apropos of 2 cases].

The authors discuss echocardiographic diagnosis and endovascular treatment of two different anatomical types of pulmonary arteriovenous fistula. Transoesophageal echocardiography in a cyanotic 3 year old boy revealed a direct right pulmonary artery left atrial fistula, treated by surgical ligation of the anomalous feeding artery. A cerebral abscess in a 22 year old man with hereditary haemorrhagic telangiectasia revealed pulmonary and cerebral arteriovenous malformations, which were both treated successfully by embolization. The value of echography is the demonstration of the right to left shunt at pulmonary level and, in some cases, the direct visualization of the arteriovenous malformation. Embolization should be considered as the therapeutic method of choice in all pulmonary arteriovenous fistula, except for direct pulmonary artery left atrial fistula.

Adult↗
PubMed1994

[Interruption of the left aortic arch with right descending thoracic aorta disclosed in adulthood].

Evaluation of hypertension, in a 30 years old man, revealed an interruption of a left aortic arch beyond the origin of the left subclavian artery, associated with a right descending thoracic artery. Surgical restoration of the continuity between the ascending aorta and the low descending aorta was successfully achieved by interposition of a graft. Survival in adulthood without bronchial compression, is explained by the absence of ventricular septal defect and patent ductus arteriosus.

Adult↗
PubMed1994

[Valvular cyst and atrioventricular canal in a child with trisomy 21].

A child with Down's syndrome with an atrioventricular canal of ostium primum type had also a blood cyst of the mitral valve. Aside more frequent complex heterotopic cysts due to migration anomalies, simple cysts are rare with only 27 cases described in medical literature. They are often symptomatic and are cured by surgical removal. Our hypothesis, in accord with recent embryologic observations, is that simple cysts situated close to the valves and fibrous ring of the heart may result from heteroplastic change of tissue coming from primitive pericardial mesothelium. This primitive mesothelium participates to the formation of the fibrous skeleton of the heart.

Atrioventricular Node↗