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Biomedical subjects

M Massetti

Publications and source records attributed to M Massetti.

At least 55 records · Page 3Linked to original sources
PubMed1998

Minimally invasive coronary surgery: surgical considerations and assessment of cardiac troponin I.

OBJECTIVE: Minimally invasive coronary artery bypass grafting (MICABG) using internal thoracic artery (ITA) without median sternotomy and cardiopulmonary bypass (CPB) become a viable option for the management of proximal left anterior descending artery (LAD) disease. Recent studies have demonstrated that cardiac troponine I (cTnI), a new highly specific diagnostic marker of cardiomyocyte damage, is a reliable marker of cardiac ischemia during heart operations under CPB. METHODS: Between February 1996 and April 1997, 14 patients (10 males, 4 females aged 41-68) underwent MICABG with single-vessel bypass grafting for LAD stenosis (n = 9) or occlusion (n = 5). Video-assisted surgery with left anterior mini-thoracotomy was performed in ten patients and vertical parasternal thoracotomy in the other four. cTnI was measured before LAD occlusion (T0), during anastomosis (T1) and 10 min (T2), 6 h (T3), 24 h (T4), 48 h (T5), 72 h (T6) after coronary reperfusion. Assay methods used a specific enzyme-linked immunosorbent autoanalyzer (Stratus) in peripheral venous blood. Control coronary angiography was performed in all patients. RESULTS: There were no operative complications, no reoperations for bleeding. cTnI concentrations were expressed in ng/ml +/- SD. Mean cTnI level was <3.85+/-1 ng/ml (range 0-32.8). Values were: T0 = 0, T1 = 0.5+/-0.1, T2 = 1.15+/-0.2, T3 = 2.16+/-0.6, T4 = 1.5+/-0.3, T5 = 0.6+/-0.02, T6 = 0.4+/-0.01. Angiography showed patent grafts in 12 patients. A 'no flow situation' was demonstrated in a cardiac symptom-free patient, with reestablishment of flow on repeat angiogram at 6 months. In the other case, early ITA graft occlusion in a patient with two-vessel disease was correlated with a higher cTnI concentration (17.8 ng/ml). Percutaneous angioplasty was performed on the right coronary artery, complicated with dissection and cardiac failure. This patient died 3 months after the MICABG despite ventricular assist device. CONCLUSION: cTnI did not increase during and after coronary artery occlusion and local immobilization of the heart. It can be used to evaluate postoperative myocardial damage on the beating heart using MICABG.

Coronary Disease↗
PubMed1998

Less-invasive heart surgery: the preservation of median approach.

OBJECTIVE: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations. METHODS: Between January and May 1997, 30 patients were operated on with a less-invasive approach. A short (6-9 cm) median incision followed by a subcomplete sternotomy permitted a limited opening of the chest without compromising the surgical exposure; a conventional central CPB was instituted and valve surgery and most of intracardiac procedures were performed without modification of the standard technique. RESULTS: No mortality was observed; morbidity was minimal. Cardiopulmonary bypass time and aortic cross-clamp time averaged 84+/-9 and 61+/-11 min, respectively. The majority of patients were extubated and discharged from the ICU early. Chest drainage lost on average 290+/-180 ml/m2. CONCLUSIONS: Despite our limited initial experience, this technique seems to provide several potential and practical advantages: there is less trauma and pain reported by patients; the small wound reduces the potential for wound infection and blood loss. Patients are extubated and discharged from the hospital earlier with lower overall costs.

Aged↗
PubMed1998

Safety of beating heart anastomosis during video-assisted coronary surgery attested by cardiac troponin I.

Our objective was to evaluate the safety of coronary anastomosis on the beating heart by measuring the release of cardiac troponin I during minimally invasive coronary artery bypass grafting (MICABG). Cardiac troponin I (cTnI) is a reliable marker of cardiac ischemia during heart operations under cardiopulmonary bypass (CPB). Ten patients (8 males and 2 females, aged 41-63) underwent MICABG with single vessel bypass grafting for left anterior descending coronary artery (LAD) stenosis (n = 7) or occlusion (n = 3). Video-assisted surgery with left anterior minithoracotomy was performed in all patients. Serial venous blood samples were collected for measurement of cTnI before LAD occlusion (T0), during anastomosis (T1) and 10 min (T2), 6 h (T3), 24 h (T4), 48 h (T5), and 72 h (T6) after coronary reperfusion. The assay method used a specific enzyme-linked immunosorbent Stratus autoanalyzer. Control coronary angiography was performed in all patients. There were no operative complications or reoperations for bleeding. The cTnI concentrations were expressed in ng/ml +/- SD. The mean cTnI level was less than 3.05 +/- 0.2 ng/ml (range 0-32.8). Values were T0 = 0, T1 = 0.4 +/- 0.03, T2 = 1.15 +/- 0.2, T3 = 2.16 +/- 0.6, T4 = 1.5 +/- 0.3, T5 = 0.6 +/- 0.02, and T6 = 0.4 +/- 0.01. Angiography showed patent grafts in 9 patients. In one case, early internal thoracic artery (ITA) graft occlusion in a patient with 2 vessel disease was correlated with a higher cTnI concentration (17.8 ng/ml). Percutaneous angioplasty was performed on the right coronary artery, complicated with dissection and cardiac failure. This patient died 3 months after the MICABG despite support from a ventricular assist device. In conclusion, collateral circulation developed in the setting of chronic coronary occlusion may be efficient for myocardial preservation during short periods such as coronary anastomosis. cTnI immunoassay confirmed the safety of coronary anastomosis on the beating heart during minimally invasive coronary operations.

Adult↗
PubMed1998

Pulmonary artery trunk leiomyosarcoma.

Pulmonary artery leiomyosarcomas are rare tumors. They cause symptoms suggestive of recurrent pulmonary emboli. As in the case reported here, the diagnosis is virtually never considered initially, despite modern diagnostic imaging methods, but usually made at autopsy or at histologic examination of material removed from the pulmonary artery at surgery. The prognosis remains poor and prolongation of life up to 6 months has not been clearly demonstrated with radical excision in conjunction with radiotherapy. The difficulty is the accurate diagnosis required to consider these tumors for curative resection, which is the only hope for a longer disease-free course.

Adult↗
PubMed1998

[Ehlers-Danlos disease revealed during pregnancy through the diagnosis of aortic dissection].

Dissection of the aorta is a serious condition but rare in young women, and occurring during the 3rd trimester of pregnancy. The main risk factors are hypertension and diseases of the connective tissue or of collagen (Marfan's syndrome and Ehlers-Danlos disease). The authors report a case of dissection of the aorta managed in a pluridisciplinary manner by the anaesthetists, cardiologists, obstetricians and cardiothoracic surgeons, which resulted in a favourable outcome for both mother and baby. The diagnosis of Ehlers-Danlos disease was made from the onset and, over a period of 10 years with CT scan and annual echocardiographic follow-up, total replacement of the supra-coronary aorta was performed in several stages.

Adult↗
PubMed1998

Recurrent left-sided heart leiomyosarcoma: should heart transplantation be legitimate?

Leiomyosarcoma of the heart is an uncommon primary malignant tumor with poor postoperative survival that may be measured in months. A leiomyosarcoma of the left atrium was diagnosed in a 47-year-old man. Initial admission was for acute pulmonary edema requiring emergency surgery. The tumor involved the left atrial cavity, and a radical resection was performed. Six months later an isolated myxomatous recurrence was detected. Heart transplantation was then performed. The patient is in good health 20 months after operation with no evidence of residual disease or recurrence. The literature has been reviewed. Surgical resection is not an adequate treatment for leiomyosarcoma of the left atrium and early heart transplantation probably offers the only hope for these patients.

Heart Atria↗
PubMed1997

Asymptomatic carotid stenosis in patients undergoing major cardiac surgery: can percutaneous carotid angioplasty be an alternative?

OBJECTIVE: As the mortality associated with coronary artery bypass grafts has fallen, morbidity has become an increasing problem. The improvement of transluminal carotid angioplasty is enlarged to patients with asymptomatic severe carotid stenosis (> 85%) requiring coronary surgery. METHODS: Between January 1993 and January 1995, 10 patients underwent percutaneous carotid angioplasty prior to cardiac surgery (17.4 days). Mean age was 71 +/- 4.3 years. Four patients showed a contralateral occlusion of the internal carotid artery. Transluminal carotid angioplasty was carried out with a triple coaxial catheter system. Six angioplasties required a Strecker stent. RESULTS: Mean follow-up was 11.4 months. No mortality was observed. Only one patient showed a transient hemianopsia. All patients underwent angiography at four months. Two patients required a new procedure of carotid angioplasty completed with a Strecker stent in one case and by dilatation of a stent in another patient. CONCLUSION: The results of transluminal carotid angioplasty, in this short series, are encouraging in this group of high-risk morbidity and mortality (elderly patients, bilateral carotid lesions, multiple coronary arterial grafts).

Aged↗
PubMed1997

Aorto-pulmonary fistula: a rare event in the evolution of a dissecting aneurysm of the thoracic aorta.

The natural history of a thoracic aneurysm is usually towards the dissection or free rupture; rarely an aorto-pulmonary fistula can complicate this lesion. We present two cases of Aorto-pulmonary fistula as acute complication of an aneurysm of thoracic aorta; the etiopathology seem to be related to the same mechanism: a dissecting aneurysm of the ascending aorta leading to a secondary fistulation in the main pulmonary artery. In our two cases the diagnosis was suggested by clinical findings and by Doppler-echocardiography. Both patients were managed surgically with success and both survived.

Adult↗
PubMed1997

Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up).

Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant. During the 10-year follow-up, multiple complex dissection required transverse aortic arch and thoracoabdominal aortic replacement.

Adult↗
PubMed1997

Leiomyosarcoma of the inferior vena cava: novel surgical reconstruction preserves renal function.

Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a new case of primary leiomyosarcoma of the inter-renal vena cava is reported. Surgical treatment consisted of excision of the vena cava on top of the renal arteries allowing radical resection. Reconstruction was original. The distal vena cava was sectioned and ligated just above the bifurcation and the free segment used to replace the excised part. In this the right venal vein was directly implanted. The left renal vein was reimplanted in the translocated segment via a venous (femoral vein) graft. Ligation of the distal vena cava was haemodynamically well-tolerated and the patient was free of symptoms at one year after operation. Control angiogram showed patency of the venous reconstruction. Early diagnosis is essential to improve patient survival, since it allows better radical resection, which is the only way of preventing the development of metastases.

Hemodynamics↗
PubMed1997

[Value of carbon in the thrombogenicity of cardiovascular prostheses].

Forty five Carbon-lined (CL) and 45 Standard (ST) 4 mm internal diameter polytetrafluoroethylene (PTFE) grafts were implanted as aortic interpositions in 90 New Zealand rabbits. In a pilot study of 20 animals, 10 CL and 10 ST grafts were used to develop microsurgical techniques, then 60 grafts were placed in 60 rabbits with lower morbidity. The 2-hour graft patency (Doppler study, Transonic flow probe and 8 mHZ) showed a better patency rate in the CL group (93% versus 80%). In 10 animals, platelet accumulation was investigated in vivo using scintigraphy after injection of autologous platelets labeled with Indium111. In vitro, radioactivity counting of the explanted midgrafts sections at 2 hours revealed a 6-fold higher activity in ST grafts (6.60 +/- 1.98 x 103 platelets/mm2 versus 0.82 +/- 0.25 x 103 platelets/mm2; p < 0.05). Light microscopy found platelet and fibrin deposition (PFD) in nearly all ST grafts, whereas PFD were found in only 13% of the CL grafts corresponding to those thrombosed grafts (chi2:61.117; p < 0.001). Carbon-lining decreases platelet accumulation on PTFE grafts and the rabbit aortic interposition appears to constitute a quantitative and reproducible model for investigation of antithrombotic drugs.

Animals↗
PubMed1996

[Associated carotid and coronary lesions: carotid endoluminal angioplasty before coronary surgery].

OBJECTIVE: There is debate over the therapeutic strategy in patients with lesions of both the coronary arteries and the carotid arteries. Improvement in angioplasty techniques for the carotid artery would be a minimally invasive alternative. METHODS: Between January 1993 and June 1995, 12 patients who underwent endoluminal angioplasty of the carotid artery before coronary bypass surgery (mean 17.9 days before) were included in the study. Mean age was 70 +/- 3.2 years. The carotid lesions were asymptomatic in all patients who had stable angina. RESULTS: The mean number of bypasses was 2.9 per patient. Five patients had a contralateral stenosis of the internal carotid artery. Angioplasty was performed under cerebral protection using a three way coaxial catheter. A Strecker stent was required in 8 cases. One patient presented transient hemianopsia. All patients were seen again at 4 months for an angiogram then at 6 months for a Doppler examination. One patient needed complete redilatation with a stent and one other required dilatation of the stent. CONCLUSIONS: Endoluminal angioplasty of the carotid arteries gave encouraging results in this high-risk population (underlying disease, age, bilateral carotid lesions, arterial coronary grafts). This technique should be used more widely for patients with severe multiple arterial lesions.

Aged↗