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Biomedical subjects

M Merlo

Publications and source records attributed to M Merlo.

At least 55 records · Page 3Linked to original sources
PubMed1991

Long-term results after atrial correction of complete transposition of the great arteries.

This study presents the late results for the first 104 consecutive patients surviving and atrial repair for transposition of the great arteries (TGA) between January 1971 and December 1978 (group 1). Mean follow-up was 12 years (range, 0.1 to 17.7 years). The actuarial survival rate at 18 years was 84.2% (70% confidence limits, 79% to 88%) for simple TGA and 93.7% (70% confidence limits, 84% to 97%) for complex TGA. Nine of the 11 deaths were sudden. Two (2.6%) of the 78 late survivors operated on for simple TGA are in New York Heart Association functional class III or IV versus 4 (26.7%) of the 15 survivors with complex TGA; the other patients are doing very well. To better assess long-term results, we report the findings for randomly obtained electrocardiograms, Holter monitor recordings, radionuclide angiographic studies, and cardiac catheterizations performed in 1987 in a larger group of 159 long-term survivors of atrial repair operated on at Ospedale Riuniti di Bergamo from January 1971 to December 1984 (group 2), which includes all of group 1. The findings confirm that the arterial switch repair is the procedure of choice for complex TGA and that there is a major incidence (approximately 10%) of systemic right ventricular dysfunction and rhythm disturbances after the atrial repair. On the other hand, our late survival rate at 18 years of 84% for simple TGA with 97.5% of the patients in functional class I is a result that should be kept in mind, especially in institutions where the arterial switch is a relatively new approach and presumably is a higher risk to cause early death.

Cardiac Catheterization↗
PubMed1991

[Hemodynamic and psychophysiologic evaluation in hypertensive diabetic patients].

In order to evaluate a peculiar hemodynamic and psychophysiological reactivity in hypertensive-diabetics, a male population of mild essential hypertensives and mild NID hypertensive-diabetics underwent a session of tests:Arithmetic, Sacks', Cold Pressor, Hand-grip, preceded and followed by a 10' recovery period, Valsalva Manoeuver, Beat to beat, Tilt table. Along the entire session, by means of a beat to beat, non invasive computerized system, we measured some pressure, hemodynamic, and extra-cardiovascular variables. The obtained findings seem to suggest a sympathetic hyperreactivity both in HD and in H. In HD it has a particular "tropism" for peripheral vascular bed, as showed by vascular resistances and peripheral temperature responsivity; on the other hand the cardiac contractility index is more depressed than in H, suggesting that in HD, cardiac and pressor responses might be influenced by some mechanisms whose nature seem related to neither functional damage nor hemodynamic adjustments. The different profiles of the two populations seem to confirm the utility of this kind of hemodynamic, non invasive evaluation in all the pathologies where Autonomic Nervous System is involved, in order to obtain a better diagnosis approach and therapeutic treatment.

Body Temperature↗
PubMed1991

[Psychophysiologic markers of arterial hypertension].

Many studies, concerning cardiovascular reactivity in hypertensives, show contrasting data. The aim of the present study was to check, also measuring extracardiovascular variables, a procedure able to identify a peculiar characteristic of the prehypertensive phase. We studied 47 normotensives, who referred high blood pressure values, but that we did not find in our visit. The cardioneurovascular assessment was evaluated, by means of a non invasive, beat to beat technique, measuring SBP, DBP, HR, muscular contraction and skin conductance level (EMG, SCL), peripheric temperature (PT), during a psychophysiologic session. This was composed by 4 stressors (mental arithmetic and Sacks test, acoustic and electric stimulations), 5 minutes each, preceded and followed by an observation period of 10 minutes. After 18 month follow-up, we could distinguish 26 hypertensives (H), and 21 subjects maintained normal blood pressure values (N). The obtained findings showed, with statistical significance, 1) the hyperresponsiveness of SCL and PT; 2) the failed recovery, with consequent hyperdysreactivity, of SCL and PT; 3) the presence of both these phenomena in the H., while SBP, DBP and HR responses did not result a discriminative tool. These data seem 1) to reinforce the hypothesis that a hypersympathetic phase can characterize the prehypertensive stages of essential hypertension and 2) to suggest the psychophysiological approach as a useful method to diagnose prehypertension.

Acoustic Stimulation↗
PubMed1990

[Pseudomembranous colitis caused by antibiotic therapy during aorto-iliac surgery].

Pseudomembranous colitis is not a rare complication of antibiotic therapy. 2000 surgical procedures with implantation of grafts in the aorto-iliac region were performed from 1974 through 1988; during this period 11 cases of CMP were observed. The Authors report their experience in regard to the various antibiotics administered.

Aorta, Abdominal↗
PubMed1990

Late left atrioventricular valve insufficiency after repair of partial atrioventricular septal defects: anatomical and surgical determinants.

Risk factors for late left atrioventricular (AV) valve insufficiency, which occurred in 16 (18%) of 90 patients evaluated after repair of partial AV septal defect, were examined. The operative findings in 9 patients undergoing reoperation were also examined. Preoperative left AV valve insufficiency was significantly more common in the group with late left AV valve incompetence, as were associated valvular malformations as a whole and fenestrations of valve leaflets in particular. Conversely, the higher incidence of malformed or malpositioned papillary muscles, accessory clefts, and double-orifice left AV valves in the group with late left AV valve insufficiency did not reach significance. The method of surgical treatment of the septal commissure was not a significant factor. In the group having reoperation, additional valvular malformations were found in association with inappropriate treatment of the septal commissure in 7 patients. The 2 remaining patients had either a directly sutured ostium primum or dilatation of the annulus. Three re-repairs were successful. Five patients required prosthetic valve replacement. Preoperative left AV valve insufficiency and associated valvular malformations are major determinants of late left AV valve insufficiency in partial AV septal defect.

Adolescent↗
PubMed1990

[The Bentall technique for the treatment of aortic aneurysms and acute aortic dissections: our experience with 24 cases].

Authors report their experience between 1981 and 1989 in the surgical treatment of 24 patients, aged 11 to 68 years, with chronic aneurysm of the ascending aorta (14 cases) or acute aortic dissection (10 cases), 7 of them being in cardiogenic shock with cardiac tamponade. In 7 patients the classic Bentall technique was employed, in 7 a modified Bentall technique and in 10 cases reimplantation of the coronary arteries was performed. In 2 cases a coronary artery by-pass, by saphenous vein graft, was placed on the right coronary artery, which was involved in the dissection. Valved dacron conduits were always employed. Two patients died after the operation whereas no late deaths were recorded in a follow-up interval ranging from 3 months to 7 years. The modifications of the classic surgical technique described in 1968 by Bentall-De Bono are of primary importance in diminishing the operative mortality and the incidence of early and late complications in these patients, whose disease nonetheless remains a surgical challenge.

Acute Disease↗
PubMed1990

[Popliteal aneurysm. Our experience in 65 cases].

Fifty patients with 65 popliteal aneurysms underwent reconstructive procedures (mean age 64). Atherosclerosis is almost the exclusive cause of popliteal aneurysms. Most of the cases showed an acute ischemia, while he others were asymptomatic or presented a complication of venous occlusion or neural compression. Numerous cases were found incidentally at amputations (these were not included). The best operational method is ligation of the aneurysm sometimes with partial resection and autologous venous graft bypass. The immediate results were excellent in all cases, loss of limb was observed in only three.

Aged↗
PubMed1990

[Clinical aspects of persistent sciatic artery. Description of 2 cases with angiographic demonstration].

We report 2 additional cases with angiographic demonstration. The embryology and radiological findings are discussed. This anomaly should be kept in mind in the clinical assessment of a patient with unexplained sciatic or buttock pain or a pulsatile buttock mass with or without symptoms of peripheral vascular disease. It also represents a potential hazard during renal transplant surgery.

Angiography↗
PubMed1990

[Aneurysms of the abdominal aorta in patients 80 and over years of age. Long term results].

During a thirteen years period 29 patients 80 years of age and older, underwent surgical procedure for abdominal aortic aneurysm. There were 9 elective aortic reconstructions and 20 ruptured abdominal aortic aneurysms (AAA) repairs. Perioperative mortality after elective AAA resection was 33% vs 50% after ruptured AAA (a postoperative period of 30 days was considered). Comparison of survival following aortic reconstruction in 14 patients with survival of general population matched for age, sex and race, is not significant.

Age Factors↗
PubMed1988

Fontan repair for tricuspid atresia: experience with 50 consecutive patients.

From April, 1975, to October, 1985, 50 patients (mean age, 5.3 years; range, 2.5 to 14 years) underwent a Fontan repair for tricuspid atresia or severe tricuspid stenosis. Fifty-six palliative operations had been performed previously in 43 patients. Twenty-nine patients received an atriopulmonary connection by direct anastomosis [19], interposition of an aortic homograft [7], or a porcine heterograft [3]. An atrium-subpulmonary chamber connection was performed in 21 patients (Björk modification, 10; Dacron tube, 10; valved conduit, 1). Eleven patients (22%) died early, 6 of whom did not meet the established criteria for a Fontan operation. One patient died 6 months postoperatively of superior vena cava thrombosis. Four patients were reoperated on successfully. At a mean follow-up of 28.8 months, 28 patients are in New York Heart Association Functional Class I and 9 are in Class II; 1 patient was lost to follow-up. Thirteen patients underwent control catheterization fifteen days to four years postoperatively (median right atrial pressure, 14 mm Hg). Exercise testing in 9 asymptomatic patients, performed after a mean interval of 33 months, showed a moderate impairment of cardiac performance. We conclude that in select patients, a Fontan repair appears to be a reliable procedure at medium-term follow-up.

Adolescent↗
PubMed1988

[Congenital coronary fistulae. Comments on 9 surgical cases].

The authors relate their experience concerning the surgical correction of congenital coronary fistula. Between May 1971 and June 1986, 9 patients (4 boys and 5 girls) aged from 17 days to 49 years were operated upon at the Division of Cardiac Surgery of Bergamo (Ospedali Riuniti). All the patients, except three who were asymptomatic, showed early cardiac failure or dyspnoea on effort and angina in the elderly. At the physical examination a continuous murmur was heard in 8 cases; the chest x-ray showed significant cardiomegaly and on the electrocardiogram a right/left ventricular hypertrophy pattern was detected in 5 patients. All the patients underwent cardiac catheterization and a coronary angiography. The left-to-right shunt ranged from 60% to 250% of the cardiac output. The anomalous communication affected the right coronary artery in 7 cases and the left in 2, opening into the right atrium in 4 patients, into the right ventricle in 3 and into the pulmonary artery in 2. All patients but one, in whom division and suture were the only necessary procedures, underwent correction by means conventional cardiopulmonary by-pass with moderate hypothermia. In 3 cases closure through the coronary artery was preferred, in 1 through the right ventricle and in 2 transpulmonary. There was only 1 late death which occurred in a 3 year-old patient due to renal failure. After a mean follow-up of 6 years, 7 patients are to be asymptomatic while 1 patient had to be reoperated for a significant residual shunt.

Adult↗