Biomedical subjects

M Giulia Gagliardi

Publications and source records attributed to M Giulia Gagliardi.

3 recordsLinked to original sources

PubMed2004

Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy.

OBJECTIVE: To describe the treatment and long term outcome after immunosuppressive treatment of children with myocarditis. METHODS AND RESULTS: 114 patients with newly diagnosed dilated cardiomyopathy were divided into three groups, according to the histological pattern: group A, acute myocarditis; group B, borderline myocarditis; and group C, non-inflammatory cardiomyopathy. Groups A and B were treated with cyclosporine and prednisone in addition to conventional treatment. Survivors of the whole cohort were analysed for 13 year transplant-free survival and assessed for left ventricular function. Event-free survival at 13 years was 97 (3)% for group A, 70 (8)% for group B, and 32 (7)% for group C (p < 0.0001). It was 96 (4)% at one year and 83 (5)% at 13 years for the cumulated myocarditis group (A and B). Cardiac function recovered completely in 79% of survivors in group A, 64% in group B, and 36% in group C. The rate of complete recovery in the cumulated group (A and B) was 70%. CONCLUSIONS: The high long term survival rate of this cohort of children with myocarditis is probably due to the effect of short term immunosuppression. This result differs from previously published series of conventionally treated children, whose survival probability at one year was about 60%.

Analysis of Variance↗

PubMed2001

Coronary microvascular endothelial dysfunction in transplanted children.

AIMS: To assess the response of the coronary microcirculation to acetylcholine (endothelium-dependent vasodilator) and of adenosine (endothelium-independent vasodilator) in children after heart transplantation and to verify whether endothelial dysfunction is time-dependent. METHODS AND RESULTS: We studied the endothelial function of 26 asymptomatic children previously submitted to heart transplantation, with normal transplanted hearts and epicardial coronary arteries. Ten untransplanted children served as controls. The response of coronary blood flow velocity to intracoronary infusion of acetylcholine (1.8 microg x min(-1)) and adenosine (270 microg x min(-1)) was assessed using a Doppler wire positioned in an epicardial coronary branch. In the study group, coronary blood flow velocity increased slightly during acetylcholine infusion (peak/baseline ratio=1.17+/-0.22). The ratio was inversely correlated with the length of follow-up (r=-0.50;P=0.0078). The peak/baseline ratio in control children was 1.76+/-0.73 (P<0.0002 vs. study group). After adenosine infusion, the coronary blood flow velocity peak/baseline ratio was 3.75+/-1.54 in transplanted children and 3.72+/-1.34 in controls (P=ns). CONCLUSIONS: Endothelial dysfunction in paediatric transplanted patients becomes more evident in patients with longer follow-up. This finding could prove useful in the prevention of accelerated arteriosclerosis.

Acetylcholine↗

PubMed1991

Is lung biopsy useful for surgical decision making in congenital heart disease?

Sixty patients with congenital heart disease (CHD), age range 3 months-45 years (median 2 years), underwent lung biopsy to exclude pulmonary vascular disease (PVD): 25 had an atrioventricular (AV) septal defect, 14 a ventricular septal defect (VSD), 7 a complete transposition of the great arteries (TGA) + VSD, 3 an atrial septal defect, and 2 a patent ductus arteriosus; 9 had other malformations. Scoring of histological section (0-4) according to a modified Heath-Edwards classification disclosed that 30 patients had severe "irreversible" PVD (greater than or equal to grade 3) (11 AV septal defect, 8 VSD, 6 TGA + VSD and 5 others); 8 patients were younger than 1 year. Pulmonary vascular resistance (PVR) was calculated in 51 patients and exceeded 7 U/m2 in 1 of 2 patients with grade 0, in 9 of 18 with grade 1, in 1 of 4 with grade 2, in 11 of 18 with grade 3, and in 8 of 9 with grade 4. PVR was also calculated after 100% oxygen administration in 19 patients, 14 of whom had a resting PVR greater than or equal to 7 U/m2. PVR persisted greater than or equal to 7 U/m2 in 5 patients: 4 had PVD greater than or equal to grade 3 and died after surgery. PVR fell to under 7 U/m2 in 14 patients, 3 of whom had PVD greater than or equal to grade 3:1 patient with grade 4 was not operated upon and 2 with grade 3 were operated upon: all are alive. Follow-up in discharged living patients was 100%, with a mean of 50 months. Fifty-five patients underwent surgery with 10 early and 2 late deaths. Among the 12 subjects with a fatal outcome, 10 had irreversible lesions. The 5 non-operated patients all had irreversible lesions at biopsy, and are still alive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗