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Biomedical subjects

L Zannini

Publications and source records attributed to L Zannini.

At least 37 records · Page 2Linked to original sources
PubMed1988

Anatomic repair of anomalies of ventriculoarterial connection associated with ventricular septal defect. II. Clinical results in 50 patients with pulmonary outflow tract obstruction.

From November 1980 to November 1985, 50 patients underwent anatomic repair of anomalies of ventriculoarterial connection associated with ventricular septal defect and pulmonary outflow tract obstruction. The technique used was one that we have previously described, which we call REV. The principles of this technique are resection of the infundibular septum, construction of a tunnel connecting the left ventricle to the aorta, and direct anastomosis, without a prosthetic conduit, of the pulmonary arterial trunk with the right ventricle. The tunnel is situated beneath the aortic valve and occupies very little space in the right ventricular cavity. Age at operation ranged from 4 months to 13 years (mean 3.5 years). Twenty-six patients had a classic type of transposition of the great arteries; all other patients had various types of anomalies of ventriculoarterial connection in which it was impossible, after the intraventricular connection of the left ventricle to the aorta, to use the natural pulmonary orifice for the pulmonary outflow tract reconstruction. There were nine hospital deaths (18%) and one late death. Twenty-six of 29 patients whose follow-up time exceeded 1 year had an excellent clinical result. No stenosis of the aortic outflow tract was found. Four patients had significant pressure gradients on the pulmonary outflow tract. Our present experience with REV suggests that this technique allows anatomic repair in a wide variety of anomalies of ventriculoarterial connection associated with ventricular septal defect and pulmonary outflow tract obstruction, even in infants, with an acceptable rate of mortality and morbidity.

Adolescent↗
PubMed1987

[Supravalvular aortic stenosis. Analysis of a surgical series of 8 patients].

Supravalvular aortic stenosis (SAS) is an unusual form of progressive left ventricular outflow tract (LVOT) obstruction, frequently associated with others vascular and physical anomalies. Between July 1980 and July 1986 eight such patients have been operated upon. In seven patients patch aortoplasty (according to McGoon or Doty technique) relieved the stenosis; in one, a two years old boy, with associated severe hypoplasia of the ascending aorta and aortic arch, a left ventricle (LV) - abdominal aorta valved conduit was associated to aortoplasty. One patient died in the operating room with a severe anterior myocardial infarction; seven patients are in good clinical condition at a mean follow-up of 32 months. The aortic supravalvular gradient was dramatically reduced in all patients according with Doppler echocardiography. In our mind, patients with SAS would benefit from an early surgical repair, because of progressive involvement of the aortic valve, coronary arteries and LV. The surgical technique is strictly related to the anatomical situations. Per and postoperative management should rely on the pathophysiology peculiar to this malformation (especially about coronary perfusion). Taking care to these points, the surgical results at a mid term follow-up are now very satisfactory in this cardiac malformation.

Adolescent↗
PubMed1987

[Carotid sinus syndrome. Description of a case treated by surgical denervation].

A 43 years old man suffering from syncopal attacks and episodes of dizziness was found as affected by right carotid sinus syndrome causing cardioinhibition. Excluding all possible specific causes of carotid sinus hypersensitivity and, by means of electrophysiological study, any intrinsic cardiac pathology, was settled that the long pauses of asystole that produce syncopal attacks were of extrinsic vagal nature. Considering the young age of the patient an operation of surgical denervation of the right carotid sinus was decided upon. This simple and riskless treatment allowed the case to be solved without resorting to permanent pacemaker implantation.

Adult↗
PubMed1987

[Transposition of the great vessels with interventricular defect and stenosis of the left ventricular efflux channel: anatomical correction by the intraventricular repair technic].

New technique of anatomical correction of transposition of the great arteries (TGV) with ventricular septal defect (VSD) and pulmonary stenosis (PS) without using a prosthetic conduit was reported by Lecompte in 1982. We analyse our recent experience with this procedure in three patients and we describe the main advantages and the wide surgical indications with reference to the Rastelli procedure.

Abnormalities, Multiple↗
PubMed1986

The use of absorbable suture: morphological findings in a newborn three months after coarctation repair.

The macroscopic and histological findings in a case of surgical repair of aortic coarctation in a newborn, performed using polydioxanone, a monofilament absorbable suture material, are reported. The persistence of suture material three months after surgery, the lack of severe inflammatory changes, calcification and elastic disruption of the arterial wall, confirm previous experimental data. For these characteristics, the use of polydioxanone in the repair of aortic coarctation in newborns is suggested, in order to avoid recoarctation, the most frequent complication of this surgical therapy.

Absorption↗
PubMed1985

[Aortic coarctation with hypoplasia of the arch: description of a new surgical technic].

The aortic coarctation is frequently associated with aortic arch tubular hypoplasia, especially in early infancy. The treatment in one time of both lesions is mandatory in these cases. We propose therefore a new surgical technique: after resection of the isthmic coarctation and appropriate cutting of both ends, the anastomosis is widely extended in the concavity of transverse aortic arch, beyond the hypoplastic region. We discuss the advantages of this technique over the classic end-to-end anastomosis, patch graft and subclavian flap angioplasty.

Aorta, Thoracic↗
PubMed1984

[Echocardiographic evaluation of pericardial effusion in acute myocardial infarct].

We have assessed the value of M-mode echocardiography in diagnosing the presence and the extent of pericardial effusion after an acute myocardial infarction, in a group of 105 patients. The relations between pericardial effusion and the extent of the infarction, the possible presence of heart failure, the clinical electrocardiographic and radiographic signs of pericarditis have also been investigated. At last we have evaluated the possible influence of the anticoagulant therapy. Our results show a poor (22%) sensitivity of the traditional methods (ECG, X-ray, physical examination) in comparison with echocardiography. This holds true both for the entire group (x2 = 85,8; p less than 0,001), and for the large effusions taken separately (x2 = 59,6; p less than 0,001). A close relation between the area and the extent of myocardial infarction and the presence of pericardial effusion was observed. On the contrary no statistically significant relation between anticoagulant therapy and the extent and frequency of pericardial effusion was found. This type of therapy seems to influence only the duration of pericardial effusion (8,875 +/- 3,1 versus 5,72 +/- 4,9 days). Haemodynamic efficiency is poorly related with the presence of pericardial effusion (X2 = 3 p greater than 0.05). This relation probably depends on the extent of myocardial necrosis. Echocardiographic investigation of the presence and extent of pericardial effusion after myocardial infarction could help to define both the prognosis and the treatment of these patients.

Adult↗
PubMed1983

[Unusual mechanism of reciprocating tachycardia in a case of ventricular preexcitation resistant to preventive anti-arrhythmia therapy].

A patient with a previously asymptomatic W.P.W. syndrome had, at the age of 60, frequent runs of paroxysmal tachycardia, which occurred particularly after meals. The paroxysms were easily controlled by pharmacological therapy in the acute stage, but could not be prevented by prophylactic therapy because of a large oesophageal diverticulum which, through right vagal reflexes, caused sinus arrests with junctional escapes that triggered the re-entry mechanism. Resection of the diverticulum abolished the tachycardia spells.

Anti-Arrhythmia Agents↗
PubMed1983

Tricuspid atresia. Results of treatment in 115 children.

We present our experience in the management of tricuspid atresia in 115 children. The anatomic data are categorized as follows: type I, 83.5%, type II, 16.5%. Type IB is the most frequent, representing 63.5% of all the cases. Each patient was operated upon one to four times. The age at first operation ranged from 10 days to 20 years. The first operation was a shunt in 94 children, a Fontan operation in four, and banding of the pulmonary artery in 17. Hospital mortality for the first operation was 12.2%, significantly higher in children under 6 months and in those having Waterston shunts. Potts and Blalock-Taussig operations give low long-term mortality; although few (six) have been done, Potts shunts also seem to give good long-term palliation in this series. The Glenn anastomosis is a good operation when performed after a systemic-pulmonary arterial shunt. The Fontan operation was performed in 24 children (hospital mortality 16.6%). There have been no late deaths after the third month postoperatively. Mean follow-up for this operation is only 2 years, but 88% of the survivors lead a normal life, two thirds of them receiving no treatment. There has been one reoperation for stenosis of a Dacron conduit with a good result. Late arrhythmias are well tolerated. In conclusion, the Fontan procedure is a good operation, but palliative procedures still allow good long-term survival.

Actuarial Analysis↗
PubMed1982

[Surgery in complex forms of transposition of the great vessels: long-term results in a series of 100 cases].

A series of 100 patients with complex forms of transposition of the great arteries (TGA) were operated upon over a 10 year period. Group 1 consisted of 13 TGA with pulmonary stenosis (PS), usually treated by an atrial baffle and direct repair of the stenosis. There was no operative or late mortality in this group and the long-term results were generally good (10/13). Group II comprised 29 TGA with ventricular septal defect (VSD) and PS. Seven Rastelli procedures gave 4 good results. Twenty two operations, associating atrial baffle, repair of VSD and PS (17 direct procedures, 5 left ventricle-pulmonary artery tube) were associated with a high mortality (5 operative and 4 late deaths) and 10 good long-term results. Group III comprised 58 TGA with VSD. Up to 1977 (n = 33) treatment consisted of atrial baffle + repair of VSD +/- removal of previous banding. Mortality was high (11 operative and 8 late deaths) with only 8 good long-term results. Since 1977, these patients have been treated by complete anatomical repair, the operative mortality of which is higher in the period under study (9/23) but the long-term results are much better. The surgical indications in our Department are based on the analysis of these results. In Group I only very significant PS is treated, either by left ventricle-pulmonary artery tube or direct repair depending on the form of the stenosis. In Group II, where the results based on atrial baffle are poor, a Rastelli procedure is preferred and especially its variants which avoid the use of prosthetic materials on the pulmonary trunk. In Group III, anatomical correction at the level of the great arteries is the routine procedure, the only point of discussion being the possibility of prior banding.

Adolescent↗
PubMed1982

Reconstruction of the pulmonary outflow tract without prosthetic conduit.

New techniques of correction of complex congenital anomalies, avoiding the use of prosthetic conduits, are presented. In transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis, the technique comprised the resection of infundibular septum, the suturing of an intraventricular baffle directing blood from the left ventricle to the aorta, and the reconstruction of the pulmonary outflow tract by direct implantation of the posterior rim of the pulmonary arterial trunk on the right ventricle, completed by an anterior patch. In most cases, the pulmonary bifurcation was translated anterior to the ascending aorta. This technique was feasible even in infants and in patients with a small VSD. Thirteen patients, from 3 months to 8 years of age, were treated by this technique, with four deaths, one residual VSD (reoperated), and eight good results (4 to 16 months). A similar repair was used in three cases of double-outlet right ventricle (DORV) with subpulmonic VSD and pulmonary stenosis or pulmonary artery banding, with two operative deaths and one good result. The same technique of pulmonary outflow tract reconstruction was used in four cases of truncus arteriosus. Two deaths were attributed to severe pulmonary regurgitation, a complication which should be prevented in future cases by a reliable method of inserting a valve in the pulmonary outflow tract. In pulmonary atresia with VSD and absent pulmonary trunk, the continuity between the right ventricle and the pulmonary branches was established via an arterial tube resected from the ascending aorta. This technique was successfully used in one child with extremely small pulmonary branches. These preliminary results led us to conclude that many complex congenital cardiac anomalies can be effectively treated without a prosthetic conduit.

Child, Preschool↗