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Biomedical subjects

M Villani

Publications and source records attributed to M Villani.

At least 19 recordsLinked to original sources
PubMed1992

[Ventricular late potentials in hypertrophic cardiomyopathy: personal contribution and analysis of the literature].

BACKGROUND: Patients with hypertrophic cardiomyopathy are at increased risk of sudden death. Recently it has been investigated whether late potentials can be useful markers of that risk in such patients, with discordant results. The aim of our study was to detect a correlation, if any, between late potentials, ventricular tachycardia and the hypertrophy extension. METHODS: Twenty-five patients were enrolled, 19 males and 6 females, mean age 40.40 +/- 15.02 years. Each underwent 24h Holter monitoring, averaged ECG, M-Mode and 2-D Echo. The hypertrophy was considered extensive (septum and free wall) or non extensive (septum and/or apex). RESULTS: Late potentials of a mean duration of 37 +/- 14.83 ms were recorded in 5/7 patients with documented ventricular tachycardia vs in none of the non tachycardia group. Sensibility was 100%, specificity 71% and predictive value 100%. Late potentials were present in 8.3% of patients with non extensive and in 30.8% of patients with extensive hypertrophy (p = NS). CONCLUSIONS: From our data it seems that extensive hypertrophy is present in about half of patients with hypertrophic cardiomyopathy, and this roughly correlates with a more frequent ventricular tachycardia and with late potentials. Furthermore, late potentials are strictly related to the incidence of ventricular tachycardia in this disease, just as in ischemic heart disease or in idiopathic dilated cardiomyopathy. The small number of our cases may not be sufficient to reach a significant statistical correlation between late potentials and hypertrophy, but we believe that the trend is very promising.

Action Potentials↗
PubMed1992

[Paroxysmal atrial fibrillation in patients with chronic ischemic cardiopathy: a study of high-resolution atrial activation].

BACKGROUND: Patients with ischemic heart disease and episodes of paroxysmal atrial fibrillation are at major risk of stroke. In order to prevent such episodes, through the identification of patients prone to atrial fibrillation, we investigated the high-resolution atriogram of 65 patients with chronic ischemic heart disease, 54 male and 11 female, mean age 60.22 +/- 9.04 years. Based on previous documented episodes of atrial fibrillation, the patients were divided into two groups: group A, 45 males and 3 females, mean age 58.92 +/- 7.68 years, without atrial fibrillation; group B, 9 males and 8 females, mean age 63.88 +/- 11.6 years, with atrial fibrillation. RESULTS: High resolution atrial duration (100-300 Hz) in group B (with atrial fibrillation) was higher than in group A (without atrial fibrillation) (140.59 +/- 16.85 ms vs 121.77 +/- 11.27 ms, p < 0.001); Non filtered atrial duration (0-300 Hz) was not different between the two groups, A and B (118.54 +/- 10.96 ms vs 123.53 +/- 18.77 ms, p = NS); The prevalence of late atrial potentials was higher in group B than in group A (60.8% vs 7.1%, p < 0.001); No relation was observed between high resolution atriogram data and echocardiographic measurements; Sensibility was 82%, specificity 81%, and predictivity 60%. CONCLUSIONS: Data from our study show that high resolution electrocardiography is a valid tool for identifying patients prone to atrial fibrillation. Such patients can be identified by the presence of "late atrial potentials" that, like late ventricular potentials for ventricular tachycardia, are correlated with atrial fibrillation. Nevertheless, a larger cohort of patients is necessary to confirm these results.

Aged↗
PubMed1990

[The midterm clinical results of myocardial revascularization with the internal mammary artery].

After a 3-year (1985-1988) experience of myocardial revascularization using internal mammary artery (AMI) grafts and after having excluded (1986) an higher operative mortality and morbidity, clinical medium-term results have been analysed. The first 144 patients discharged alive after AMI bypass surgery in 1985 were clinically evaluated, with a mean interval of 21 months from surgery (range: 5-29 months). Exercise electrocardiographic test was performed by 100 patients, and angiography repeated in 15. Actuarial survival function was estimated by Cutler-Ederer method: 2-year actuarial survival was 99.3 +/- 0.7% (94 +/- 1.8%, when operative deaths were included). Non fatal myocardial infarction occurred in 3 patients and, at follow-up, 26 were symptomatic for angina: 2 patients underwent re-operation and 2 angioplasty. Two years after AMI bypass surgery, actuarial estimate of ischemic event-free patients was 70.9 +/- 4.5% (67.7 +/- 4.5%, when operative deaths were included): 73 out of 100 exercise tests were negative for both angina and ischemia, although only 43 patients, reached maximal work load; 9 were positive for both angina and ischemia and 18 for ischemia only. All patients who underwent angiographic evaluation (15 patients, 11 of whom because of angina relapse) had AMI grafts open, while in only 4 patients all the implanted grafts were open.

Aged↗
PubMed1979

Atrio-ventricular canal malformations. Recent surgical techniques.

Twenty patients with atrio-ventricular canal malformations (5 complete and 15 partial forms) were operated upon during the last two years, using new surgical techniques. The repair of the complete form based on a three-leaflet three-commissure mitral valve concept, was accomplished by: a) Two separate partitioning patches (one ventricular, one atrial), b) mitral and tricuspid valve attachment in between, c) no cleft sutures, d) correction of subvalvular apparatus abnormalities, e) commissuroplasty. The repair of the partial form was obtained by: a) Valvular and subvalvular repair of the lesions when present, b) patch closure of the ostium primum defect suturing on the tricuspid side. All patients survived operation and exhibited normal sinus rhythm. Residual mitral incompetence proved to be less frequent as compared to previous techniques.

Adolescent↗
PubMed1979

Transposition of the great arteries. Successful Senning's operation in 35 consecutive patients.

Mustard's operation for TGA (transposition of the great arteries) has been obstructive complications. In order to try to avoid these complications, we used Senning's operation for TGA. Our experience in 35 consecutive cases is reported. There were no operative or late deaths. Four patients had a PDA; three had a significant VSD with subpulmonary stenosis in two. Previous atrial septectomy and persistent LSVC did not represent contraindications to this procedure. The postoperative course has been smooth and uneventful in all patients. Follow-up periods of one to twenty months demonstrated sinus rhythm in all patients and there were no significant gradients between the venae cavae and the new systemic atrium in 12 reinvestigated patients. On the basis of these results, Senning's operation is recommended as a valid alternative to Mustard's operation.

Cardiac Catheterization↗
PubMed1979

Results of systemic-to-pulmonary artery anastomosis for tricuspid atresia with reduced pulmonary blood flow.

Fifty-six patients with tricuspid atresia and decreased pulmonary blood flow received a systemic-to-pulmonary artery anastomosis as a preliminary operation. Thirty-five had a Waterston shunt, 12 a Blalock-Taussig anastomosis, and nine various other procedures. The age at operation ranged from 2 days to 10 years (median 4.5 months). Pulmonary atresia was present in eight newborn infants. Four patients (7%), all less than 3 months old, died in hospital from persistent servere hypoxia despite the palliative procedure. By actuarial methods, 93% of the survivors were alive at and after one year (longest follow-up:9.8 years), while 83% had not required further palliation at and after four years from the first operation. None of the patients subsequently restudied had raised pulmonary pressure or resistances, and in most of them the pulmonary arterial tree was deemed adequate for the Fontan operation.

Age Factors↗
PubMed1979

[Ventricular septal defect associated with aortic regurgitation. Results and surgical considerations in pediatric age group (author's transl)].

The Authors report their experience on the surgical treatment of ventricular septal defect and aortic regurgitation. Out of 13 patients operated upon, four required aortic valve replacement; five patients were treated with plasty of the aortic leaflets and four with the only patch closure of the V.S.D. There have not been reported hospital or late deaths. In one case, after the aortic plasty, the aortic regurgitation became severe; this patient had shown clinical signs of aortic regurgitation for more than five years before the operation. The Authors emphasize the surgical aggressiveness in this lesion when the aortic regurgitation has recently showed, whereas it is preferable to delay the operation when the aortic regurgitation has been present for more than five years.

Aortic Valve Insufficiency↗
PubMed1979

[Autoptic findings and anatomo-clinical correlations in subjects who died after repair of tetralogy of Fallot (author's transl)].

The postoperative course and the post-mortem findings of a group of 30 patients who died after repair of tetralogy of Fallot were reviewed. A residual ventricular septal defect was the most common finding at the autopsy (13 patients = 43%) while a severe residual obstruction to the right ventricular outflow was found in 5 patients (17%), miscellaneous lesions in 3 (10%) and no intracardiac defects in 9 (30%). Since a residual anatomic defect is frequently responsible for the hospital mortality, prompts hemodynamic evaluation and reoperation is recommended when the postoperative course is deteriorating.

Autopsy↗
PubMed1979

Experience in palliative treatment of univentricular heart including tricuspid atresia.

Over a period of ten years 110 patients with univentricular heart, including cases with tricuspid atresia, received palliation. The overall hospital mortality was 14.5%. Late mortality during a mean follow-up period of two years, was 6%. A group of patients with univentricular heart ("complex" group: 21 cases) had numerous and significant associated anomalies which affected the surgical results (16 survivors). Eight patients were discovered to have univentricular heart only at open heart surgery (5 survivors). In the remaining patients hospital mortality was 7.4% (6/81). As compared with the natural history these results indicate that palliative surgery is still an effective type of treatment for these two severe cardiac malformations.

Heart Defects, Congenital↗
PubMed1978

Open-heart palliative surgery for pulmonary atresia with ventricular septal defect and hypoplastic pulmonary arteries.

The surgical management of pulmonary atresia with ventricular septal defect (VSD) and hypoplastic pulmonary arteries poses difficult problems. Adequate palliation was achieved in two such patients by restoring continuity between the right ventricle and the pulmonary arteries by means of a woven Dacron patch. The VSD was left unrepaired. Angiography performed one month after operation showed the reconstructed pulmonary outflow tract to be widely patent and the pulmonary arteries to be enlarged. This approach may allow subsequent total correction by closure of the VSD in these hopeless patients.

Blood Vessel Prosthesis↗
PubMed1978

[Corrective surgery of double-outlet right ventricle and subaortic ventricular defect. Report of 12 cases surgically treated (author's transl)].

Experience with corrective surgery in 23 pts with double outlet right ventricle (DORV) and subaortic VSD is presented. The overall hospital mortality was 17%. Patients were divided into two groups: Group I includes seven cases without pulmonic stenosis and Group II sixteen cases with pulmonic stenosis. Six of Group II required a sistemic to pulmonary artery shunt earlier in life. Anatomic and clinical aspects in both groups are described as well as indication for surgery. The importance of angiocardiography for a precise diagnosis is emphasized. Problems related to management and complications are discussed; in particular how to avoid LVOTO in case of restrictive VSD and RVOTO in patients with pulmonic stenosis.

Adolescent↗
PubMed1978

[The Senning operation for correction of transposition of the great arteries (author's transl)].

The reported incidence of the main complications related to the Mustard operation for correction of transposition of the great arteries seems to be quite high: more than half patients develop arrhythmias and about one third develop venous (pulmonary or sistemic) obstructions. For these reasons we have reconsidered the type I (1959) Senning operation. Ten children below two years of age (body weight ranging from 3.9 to 12 Kg) have been operated on with this technique at our Institution. Nine were D-TGA and one L-TGA. One patient had a small VSD and three had mild pulmonary outflow stenosis (p less than 30 mmHg). All patients survived operation and none suffered from complications. At the time of the discharge from the Hospital all were in sinus rhythm. Late evaluation (24 hours EKG, cardiac catheterization, etc.) is in course. We believe that the Senning operation is easier to perform than the Mustard operation because of its more standardized technique which respects the internal geometry of the heart. Additional advantages are: 1) the intra-atrial conducting pathways are less likely to be damaged; 2) there is a minimal or no need for artificial tissues.

Child, Preschool↗