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M Cotrufo

Publications and source records attributed to M Cotrufo.

At least 91 records · Page 5Linked to original sources
PubMed1996

Submitral left ventricular aneurysm. Report of 2 surgical cases.

Submitral left ventricular aneurysm most commonly occurs among the black population. Nevertheless, this lesion has been described among whites. We report 2 cases of submitral left ventricular aneurysm that we treated successfully by surgery. Case 1 is that of a 52-year-old Brazilian black man with a submitral left aneurysm and mitral incompetence. Case 2 is that of a 25-year-old white man with a history of recurrent stroke; his echocardiographic study showed a small submitral left ventricular aneurysm. Due to the growing incidence of submitral left ventricular aneurysm among the white population, we emphasize the importance of a targeted echocardiographic study in all patients with a history of embolic episodes in the absence of apparent risk factors for embolism.

Adult↗
PubMed1995

Long-term follow-up of different models of mechanical and biological mitral prostheses.

Three hundred eighty-five valve prostheses were implanted between 1974 and 1981 in patients with isolated mitral disease: 157 caged-ball valves (156 Starr-Edwards; 1 Smeloff-Cutter) (group A), 107 tilting-disc valves (44 Bjork-Shiley, 49 Sorin, 14 Lillehei-Kaster) (group B), 121 porcine bioprostheses (45 Carpentier-Edwards, 66 Liotta, 10 Hancock) (group C). Perioperative mortality was 9.5% in group A, 11.2% in group B and 6.6% in group C. The follow-up was 86% complete. Actuarial freedom from complications was calculated as follows (linearised rates in brackets) in groups A, B and C, respectively: survival: 47.01% +/- 0.11 (3% patient/yr), 53.37% +/- 0.08 (1.8% patient/yr), 61.24% +/- 0.05 (2.2% patient/yr); thromboembolism: 67.94% +/- 0.09 (1.18% patient/yr); 73.07% +/- 0.06 (1% patient/yr); 97.43% +/- 0.02 (0.02% patient/yr); anticoagulation-related hemorrhage: 84.10% +/- 0.13 (0.18% patient/yr), 97.21% +/- 0.01 (0.12% patient/yr), 100%; prosthetic valve endocarditis: 100% in groups A and B, 95.76% +/- 0.02 (0.18% patient/yr) in group C; valve-related mortality: 87.52% +/- 0.03 (0.75% patient/yr), 87.96% +/- 0.03 (0.56% patient/yr), 82.53% +/- 0.04 (0.93% patient/yr); valve failure: 81.22% +/- 0.07 (0.56% patient/yr), 63.36% +/- 0.1 (1.06% patient/yr), 14.31% +/- 0.05 (4% patient/yr); treatment failure: 78.81% +/- 0.05 (1.12% patient/yr), 76.44% +/- 0.09 (0.62% patient/yr), 80.97% +/- 0.04 (1% patient/yr); all valve-related morbidity and mortality: 40.43% +/- 0.13 (1.93% patient/yr), 57.76% +/- 0.08 (1.43% patient/yr), 14.96% +/- 0.05 (4.18% patient/yr); all valve-related morbidity and mortality at 5 years: 91.97% +/- 0.02 (7.8% patient/yr), 87.06% +/- 0.03 (3.6% patient/yr), 90.27% +/- 0.03 (2.6% patient/yr); at 10 years: 80.4% +/- 0.03 (4.6% patient/yr), 75.91% +/- 0.03 (2.6% patient/yr), 37.44% +/- 0.05 (4.18% patient/yr).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Stentless fresh pulmonary homograft in mitral position.

We report the implantation of a fresh, stentless pulmonary homograft in the mitral position as an attempt to treat the 2nd recurrence of prosthetic endocarditis in a 66-year-old man. The postoperative course was uneventful; early postoperative transesophageal echocardiography showed a competent valve with a gradient of 4.2 mmHg. Fifteen months postoperatively, transthoracic echocardiography showed a good functioning homograft with a competent valve and no recurrence of endocarditis.

Aged↗
PubMed1994

Non-inflammatory aortic root disease and floppy aortic valve as cause of isolated regurgitation: a clinico-morphologic study.

A clinico-morphologic study was performed on 1120 patients who underwent aortic valve replacement at the Department of Medical and Surgical Cardiology, 2nd University Medical School of Naples, Naples, Italy, from January 1981 through December 1991. In 69 cases the aortic valve was incompetent due to a non-inflammatory aortic root disease such as myxomatous infiltration of the cusps and or aortic root dilatation. Among these patients males were prevalent (male/female ratio = 2.2). The mean age was 37 +/- 7.5 years. A floppy mitral valve was diagnosed in 16 cases while in one a left atrial myxoma was found. The patients were divided into 3 groups: Group 1-29 patients with aortic root dilatation and normal cusps; Group 2-25 patients with aortic root dilatation and myxomatous infiltration of aortic cusps (floppy aortic valve); and Group 3-15 patients with floppy aortic valve and undilated aortic root. At the gross examination the cusps of the patients in Groups 2 and 3 were redundant, thin, soft and gelatinous. The histology showed myxomatous infiltration with disruption of the fibrous layer. In patients with aortic root dilatation the histology of the aortic root fragments showed a cystic medial necrosis. Deep correlation was found between the root dilatation and the grade of aortic wall cystic medial necrosis. Cusp's diastasis was the cause of aortic regurgitation in patients with aortic root dilatation, while cusp prolapse caused aortic incompetence in presence of the floppy aortic valve and undilated aortic root.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Prosthetic valve obstruction: thrombolysis versus operation.

An acute obstruction is a life-threatening complication of mechanical valve prostheses, and is caused by the formation of fresh clot or fibrous tissue overgrowth, or both. Accurate selection of the most appropriate treatment for a particular patient is mandatory. From January 1991 to July 1992, 28 cases of prosthetic thrombosis were managed. Twenty patients underwent surgical treatment, with one operative death, and 8 patients were treated with thrombolysis using recombinant tissue-type plasminogen activator (rt-PA). The criteria for using thrombolysis were (1) the recent onset of symptoms, (2) transesophageal echocardiographic evidence of clots on the valve or cardiac chambers, and (3) preserved disc excursions. All patients who underwent thrombolysis had mechanical valves (two bileaflets, four tilting discs, and two ball valves); seven valves were in the mitral position and one was in the aortic. Symptoms of obstruction consisted of cardiac failure in 6 cases or thromboembolism in 5, or both. The mean interval between the onset of symptoms and the initiation of thrombolysis was 81 +/- 65 hours. After infusion of the rt-PA, normal valve function was restored in all patients, as documented by transesophageal echocardiography. No deaths or neurologic complications occurred; there was one episode of minor peripheral embolism. Thrombolysis using rt-PA may be the appropriate treatment in patients with primary thrombosis of mechanical valves, thereby avoiding the operation-related risks.

Adult↗
PubMed1994

[Role of transesophageal echocardiography in aortic dissection].

Aortic dissection, especially type A, is a life-threatening condition, that requires a prompt and accurate diagnosis to ensure a rapid and precise therapeutic approach. Transesophageal echocardiography (TEE) is a highly reliable technique because of its sensitivity and specificity (near 100%; almost similar to nuclear magnetic resonance), and because it is a very low risk, rapid and easy diagnostic tool. Two hundred sixty-one patients were admitted at our institution in a 6-year period (1988-1994), because of a suspicion of aortic dissection. Two hundred forty-seven of them were submitted to TEE and the diagnosis was compared with surgical data in 124. There was only one false positive by TEE. Sensitivity of TEE vs surgery was 100%, specificity 93.7%, diagnostic accuracy 99%. Agreement between TEE and surgery in the setting of intimal tear was 69.2%. These data confirm the usefulness of TEE in the diagnostic approach to aortic dissection and the therapeutic decision, without using other methods.

Adolescent↗
PubMed1994

[Current cardiologic diagnosis of infective endocarditis].

This report shows the importance of non-invasive techniques in infective endocarditis (IE) diagnosis. ECG is quite specific in identifying perivalvular extension of infection when conduction system disease is demonstrated but has a low degree of sensitivity overall. Our casuistry (76 patients with IE) confirms the literature data about the great importance and the utility of transthoracic and transesophageal echocardiography to detect vegetation presence or complications as abscesses or valvular leaflet perforations. Therefore, these techniques are widely applied to predict major clinical events as embolism and death or to suggest a surgical therapy. Nuclear medicine studies play a minimal role. Magnetic resonance imaging appears to be an effective tool in this setting; however, because of a paucity of clinical data, its precise utility has not yet been determined.

Adolescent↗
PubMed1994

[Infective endocarditis today; heart surgery in its treatment: how and when].

The authors report the experience of 161 surgical cases operated between 1980 and 1992 because of valve endocarditis. Two hundred and two surgical procedures were performed. Patients were divided into two groups: Group I (EN) considered 117 patients with endocarditis on the native valve; Group II (EP) included 64 patients with prosthetic endocarditis. In 23 patients the prosthesis was implanted for previous endocarditis on the native valve (EP1); in 41 patients the prosthesis was implanted for other valve diseases (EP2). Each group was described according to sex, age, site of endocarditis, previous cardiac diseases, socio-economical level, hemodynamic and infective conditions at surgery, etiology of endocarditis, surgical indication, pathology report, surgical procedure and results. The results were evaluated considering surgical mortality, late mortality and recurrence of endocarditis. The main risk factors were correlated to overall survival and recurrency. Hospital mortality was 7.6% in EN, 13% in EP1, 36.5% in EP2; endocarditis recurrency was 20.3% in EN, 65% in EP1, 19.2% in EP2. Sixteen patients with prosthetic endocarditis were submitted to a second reoperation with 50% mortality; 4 patients to a third reoperation with 50% mortality; 1 patient to a fourth reoperation with no mortality. Actuarial overall survival was 40.3% at 12 years in Group EN, 33.3% at 12 years in Group EP1, 73.4% at 12 years in Group EP2. Finally the Authors report the experience of 12 stentless grafts (autologous, homologous and eterologous) implanted between March 1991 and July 1994 in patients with valve or prosthetic endocarditis with no recurrency at 42 months of follow-up.

Actuarial Analysis↗
PubMed1994

New surgical technique for harvesting the internal mammary artery.

Inadequate flow and limited length can be reasons for not using the internal mammary artery graft for myocardial revascularization. Several methods have been described to obviate these limitations, but each has disadvantages that contraindicate their application on a routine basis. Herein we describe what to the best of our knowledge is a new surgical technique of harvesting the internal mammary artery graft wherein the endothoracic fascia is incised longitudinally along the artery. In our experience, this surgical maneuver enables an increase in hematic flow (average, 30.6%) and in length of the graft (average, 10%) with reduced risk of damaging the arterial intima. This technique also enables the surgeon to detect the presence of atheromatous plaques and of parietal hematomas of the internal mammary artery wall. Moreover, we have observed a drastic reduction in the incidence of arterial spasms after use of this technique.

Humans↗
PubMed1994

[Biennial experience with aortic valve homografts prepared and preserved in our bank and implanted on the left ventricular outflow tract in adult patients].

A homograft bank was established in 1986 at the Institute of Cardiac Surgery of the Second University of Naples. Since then 163 aortic and pulmonary homografts have been collected, and mostly used for right ventricular outflow tract reconstruction (69 at our Institution and 14 at other Italian Centers). In March 1991 free aortic homografts were first implanted in the left ventricular outflow tract in adult patients with aortic valve and/or root disease, for a total of 15 implantations with a follow-up ranging between 3 and 19 months (mean 10 months). According to the literature and our data, operative mortality for such procedure is not higher than for ordinary aortic valve replacement. With regard to mid-term failure rate and complications, homografts are to be preferred as they don't require anticoagulation. Moreover the best indication to free homograft implantation is active aortic valve endocarditis, especially when annular abscesses are present. Reinfection rate is lesser in these patients compared to those with mechanical or bioprosthetic valves because homografts have no prosthetic material, allow exclusion of abscessual cavities from blood flow and do not require the fixation of a rigid prosthetic sewing ring in an infected, friable annulus. Finally short and mid-term haemodynamic evaluations of such patients are excellent for all the aforementioned reasons as well as for the homograft non obstruction rate.

Adolescent↗
PubMed1994

Short-term results of bovine internal mammary artery use in cardiovascular surgery.

Over a 14-month period, 28 bovine internal mammary arteries (Bioflow, Bio-Vascular, Inc.; St. Paul, Minnesota, USA) were implanted in 20 patients at our institutions. In 8 patients, the bovine internal mammary artery was used to bypass coronary vessels: in 4 of these patients, coronary artery bypass grafting was performed because of coronary disease (1 type-I aortic dissection); in the other 4 (all with aortic dissection), the modified Bentall technique was used for coronary artery reimplantation. In the remaining 12 patients, the bovine artery was used in vascular surgery: as a graft for lower-extremity occlusive disease (4 patients), arteriovenous fistula (2 patients), and aorticorenal bypass (1 patient); and as a patch to the carotid bifurcation or the common femoral artery in association with endarterectomy (5 patients). The 21 bovine grafts were all 5 mm in diameter; the 7 bovine patches were 4 mm. Of the 8 coronary bypass patients, 2 who underwent coronary artery bypass grafting had acute postoperative myocardial infarctions, and 2 who underwent the modified Bentall technique died in surgery. Follow-up angiography showed complete bovine internal mammary artery graft occlusion in 2 patients; 2 symptom-free patients refused examination. Of the vascular surgery patients, 1 with mild left leg claudication had graft occlusion, shown by angiography, 4 months after surgery. Renal scintigraphy performed in the patient with aorticorenal bypass 4 months after operation showed no blood flow to the kidney. Two patients died for reasons unrelated to bovine mammary artery grafting. The remaining patients are well and free of complications. In view of the high incidence of early occlusion, we do not recommend use of the bovine internal mammary artery graft in coronary surgery. In vascular surgery, the results are more encouraging; however, studies comprising a larger number of patients and longer follow-up are needed to determine whether the use of the bovine internal mammary artery graft can be recommended.

Adult↗
PubMed1994

Early experience with the Jyros bileaflet valve in the mitral position: high incidence of valve thrombosis.

The Jyros valve is a new bileaflet valve with the unusual feature that the hinge is expected to rotate continuously inside the housing. Nine isolated Jyros mitral prostheses were implanted from July to October 1993. All patients survived the surgical procedure and during the follow up underwent transthoracic (TTE) and transesophageal echocardiograms (TEE) for the evaluation of hinge rotation. Neither TTE nor TEE were able to show hinge rotation in any patient at any time. Five patients had prosthetic thrombosis. In the successfully treated with thrombolysis. In the remaining patient thrombolysis was contraindicated. Eight patients are alive; one died of gastro-intestinal bleeding a few months after discharge. The absence of hinge rotation may be the triggering mechanism of valve thrombosis although no explanted prostheses were available for examination. Further studies are necessary to understand the mechanism of valve thrombosis with the Jyros bileaflet prosthesis.

Adult↗
PubMed1994

Long term results of surgery for prosthetic valve endocarditis.

Operative mortality, recurrence and late survival were analyzed in 64 patients operated for prosthetic valve endocarditis (PVE) between 1980-1992: age, sex, drug addiction, early vs. late PVE, micro-organism, sepsis at the time of surgery, indication for surgery, prosthesis type and site were assessed as potential risk factors. PVE developed after replacement for native valve endocarditis in 23 cases (Group A) and after replacement for other valvular disease in 41 patients (Group B). The overall operative mortality was 28.1% (18/64); 16 operative survivors underwent a second reoperation with eight operative deaths (50%), four of them a third procedure with two operative deaths (50%), and one patient had a successful fourth intervention. Female sex (p = 0.015) and sepsis at the time of surgery (p = 0.013), were found statistically significant independent predictors of operative mortality. Age (p:0.002), mechanical valves (p:0.05) and mitral position (p:0.03) were significant predictors of PVE recurrence. None of the risk factors considered were significant for late survival. Twelve-year actuarial survival for all patients was 52.11 +/- 10%; it was 33.3 +/- 13% for Group A and 73.4 +/- 14% for Group B (p:0.04). Patients with mechanical valves and bioprostheses had an actuarial survival of 39.5 +/- 15% and 48.5 +/- 14% respectively with no significant difference. PVE is still a challenging complication of heart valve replacement; patients with PVE after native valve endocarditis have a very poor outcome. Prompt prosthetic replacement is recommended whenever the antibiotic treatment is unsuccessful and/or the hemodynamic status deteriorates.

Adult↗
PubMed1993

Mid-term follow-up after heart valve replacement with CarboMedics bileaflet prostheses.

The CarboMedics cardiac prosthesis (CarboMedics, Inc., Austin, Tex.) is a relatively new, low-profile bileaflet prosthesis. We report the results of a prospective mid-term evaluation of 426 CarboMedics prostheses implanted at our institution. Three hundred fifty patients had CarboMedics prostheses implanted in the mitral (n = 125), aortic (n = 149), or aortic and mitral positions (n = 76). Hospital mortality was 5.2%. Follow-up was 98% complete, with 478 patient/years and a mean follow-up of 19 months (range 1 to 42 months). Actuarial freedom from complications were calculated as follows (linearized rates in parentheses): late mortality 97% +/- 0.77% (2.7%), thromboembolism 98% +/- 0.4% (0.5%), anticoagulation-related hemorrhage 98.6% +/- 0.4% (0.4%), nonstructural dysfunction 98.5% +/- 0.6 (0.2%), valve-related mortality 91.5% +/- 0.7 (0.5%), valve failure 90.9% +/- 1% (0.7%), treatment failure 92.8% +/- 0.8% (0.7%), and all valve-related morbidity and mortality 90% +/- 2% (2.6%). According to our results, the CarboMedics valve has a low rate of complications that further improves the quality of life in patients with heart valve prostheses.

Adolescent↗
PubMed1992

Surgical pathology of the mitral valve: gross and histological study of 1288 surgically excised valves.

A consecutive series of 1288 mitral valves surgically excised from 1981 through 1989 were studied macroscopically and histologically. The explanted valves were affected by: chronic rheumatic disease (1179, 91.5%), floppy mitral valve (84, 6.5%), bacterial endocarditis (19, 1.5%), and post-ischemic mitral incompetence (6, 0.5%). Among 1179 post-rheumatic cases, mixed mitral stenosis and incompetence was the most frequent malfunction (747, 58%). Isolated mitral incompetence was diagnosed in 72 (6.11%) cases only, and isolated stenosis in 360 cases. In 52 valves, excised because of chronic rheumatic disease, the histology showed unexpected signs of acute rheumatism of the leaflets and the papillary muscles. In these patients clinical symptoms and blood tests were negative for rheumatic disease. Mitral incompetence, possibly due to papillary muscle dysfunction, was the prevalent lesion (61.5%). A total of 181 patients (14.05%) with pure mitral incompetence underwent surgery. In 84 patients (46.4%), the floppy mitral valve was the most frequent cause of valve dysfunction, 72 (39.8%) had rheumatic disease, 19 (10.5%) infective endocarditis, and 6 (3.4%) ischemic heart disease. In the group with floppy mitral valve, males were more prevalent than females (51:33). The mean age of the 4 patients with Marfan's syndrome and non-Marfan patients was noticeably different (17 vs 49 yr). Moreover leaflet deformation, tendinous cord elongation and annulus dilatation were the most common causes of valve incompetence. Floppy mitral valve and infective endocarditis were the cause of cordal rupture in 43.5% of the cases. This was a severe complication which always required emergency surgery.

Adult↗
PubMed1992

Acute thrombosis of prosthetic valves: a multivariate analysis of the risk factors for a lifethreatening event.

In 3231 prosthetic valves implanted between January 1975 and November 1990, we observed 61 cases of prosthetic obstruction of biological origin with clinical and laboratory findings of severe functional impairment which required surgery as emergency treatment. The hospital mortality was 19.67% (12/61). The obstruction was due to a primary thrombosis in all 5 bioprostheses which were not anticoagulated and in 11/56 (19.64%) mechanical prostheses of which 3 were not anticoagulated and 4 were not properly anticoagulated. The obstruction was due to fibrous tissue overgrowth in the other 45 mechanical prostheses (80.35%) with secondary thrombosis in 34 cases (60.71%) and no thrombosis in 11 (19.64%); 71.11% of these prostheses were adequately anticoagulated. Of the 61 obstructed prostheses, 53 were mitral and 8 were aortic. No tricuspid obstruction was observed. A statistical assessment by multiple correspondence, cluster and chi square analysis was performed in two groups of patients with different models of mechanical mitral prostheses. The 5-year actuarial incidence of obstruction was 6.08%. Significant risk factors were: tilting disc prostheses, prostheses without pyrocarbon coating, large prostheses, tilting disc prostheses with a small orifice posteriorly oriented, atrial fibrillation, enlarged left atrium, time from implant greater than 4 years, age between 40 and 50 years. In our opinion, prosthetic obstruction may be referred to a primary thrombosis only in cases where it may be prevented by adequate anticoagulation. In most cases, the obstruction is produced by periprosthetic fibroblastic proliferation which may develop in spite of adequate anticoagulation in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗