PubMed Health⌕ Search

Biomedical subjects

N C Cavarocchi

Publications and source records attributed to N C Cavarocchi.

At least 19 recordsLinked to original sources
PubMed1992

Ischemia of the interventricular septum. A mechanism of right ventricular failure during mechanical left ventricular assist.

Right ventricular failure has been noted in up to 25% of patients requiring a left ventricular assist device. Altered septal motion or function is one proposed mechanism of right ventricular failure during left heart bypass. We studied the effect of regional ischemia and reperfusion of the interventricular septum on right ventricular function during complete left heart bypass. In six calves the septal perforating branches of the proximal left anterior descending coronary artery were isolated for intermittent occlusion. Complete left heart bypass was established with a Pierce-Donachy left ventricular assist device. Right and left ventricular function were studied with two-dimensional echocardiography and with intraventricular pressure monitors. Establishment of left heart bypass did not significantly affect right ventricular developed pressure, right ventricular end-diastolic area, or right ventricular fractional change in area. Left heart bypass significantly (p less than 0.001) decreased percent systolic septal wall thickening. Septal ischemia during left heart bypass resulted in a decrease in right ventricular developed pressure (p = 0.09), significant increase in right ventricular end-diastolic area (p = 0.002) and significant decrease in right ventricular fractional change in area (p less than 0.001), and a further decrease in interventricular septal wall thickening (p = 0.016). The interventricular septum became thin with flattening of its normal contour. Septal reperfusion resulted in right ventricular recovery with significant improvement in all factors (p less than 0.02). Similar results were documented during a second episode of septal ischemia with recovery after septal reperfusion. In some cases, septal ischemia may be an important factor in the development of right ventricular failure during left heart bypass.

Animals↗
PubMed1990

Endomyocardial biopsy: variations in venous access for endomyocardial biopsy in cardiac transplantation.

With the increasing number of cardiac transplantation procedures performed worldwide, a strategy for endomyocardial biopsy techniques has evolved at our institution. Specific approaches for venous access for biopsy purposes are described. These include approaches via the right internal jugular vein, right external jugular vein, left subclavian vein, and the femoral veins. Particular emphasis is placed on the technical nuances of each approach. In approximately 2,000 endomyocardial biopsies performed on 155 transplant patients from 1984-1989, only two major complications occurred, only one of which required operative intervention. This was a perforated right ventricle, and the patient recovered after repair without further sequelae. No pneumothoraces or infection occurred during this time period. With proper understanding of regional anatomy, fluoroscopic appearance, and experience, endomyocardial biopsies can be performed with an extremely low incidence of major or minor complications.

Biopsy↗
PubMed1989

Heart/heart-lung transplantation. The domino procedure.

Orthotopic heart transplantation has become an accepted therapeutic modality limited only by availability of donor organs. Heart-lung transplantation is also being performed with increasing frequency due to improvements in distant procurement techniques. Although the majority of patients requiring heart-lung transplantation have cardiac dysfunction, there is a subset with no cardiac compromise that can serve as donors of cardiac allografts before heart-lung transplantation. We report a technique for sequential heart/heart-lung transplantation in such a subset of patients.

Adult↗
PubMed1989

Cognitive function in patients with symptomatic dilated cardiomyopathy before and after cardiac transplantation.

Pre- and postoperative cognitive performance of candidates for heart transplantation was examined by means of an extensive battery of neuropsychological measures. A total of 54 patients completed the preoperative cognitive protocol, 20 of whom also completed postoperative testing. Age (less than 50 or greater than or equal to 50 years of age) and the primary cause of cardiac deterioration (idiopathic, ischemic disease or rheumatic/congenital defects) were the major classification variables. The main findings of this study were: 1) Preoperative neuropsychological measures revealed a high frequency of impaired performance, particularly in measures of memory, higher level processing of information and motor speed. A pattern consistent with diffuse rather than focal or lateralized cerebral deficits was observed. Significant differences were not found on the basis of the cause of cardiac disease, but some were observed for age (the older group was more impaired). 2) A comparison of pre- and postoperative cognitive scores failed to show significant cognitive improvement despite greatly improved physical health. The cause of cardiac deterioration was not differentially associated with postoperative cognitive performance, and there was equivocal evidence for age effects. These findings may have implications for the selection of transplant recipients and the timing of transplantation surgery.

Adult↗
PubMed1988

A shorter hospital stay after cardiac pacemaker implantation.

In an effort to shorten the hospital stay after implantation of a permanent cardiac pacemaker, some physicians have begun performing pacemaker implantation on an ambulatory basis. To assess the potential safety of shortening the duration of hospitalization after pacemaker implantation, we reviewed the complications that occurred in 100 consecutive patients after pacemaker implantation and noted the time after the implantation when the complications occurred. In our study group, all complications that necessitated invasive intervention occurred within 24 hours after the pacemaker implantation. Complications that necessitated noninvasive programming occurred as long as 72 hours after implantation, and all could have been safely corrected at the time of follow-up had the patient been dismissed at the 24-hour period. Although we do not believe that ambulatory pacemaker implantation should be routinely implemented at this time, the practice of dismissing patients at 24 hours after pacemaker implantation and scheduling subsequent outpatient follow-up seems to be safe and effective.

Adolescent↗
PubMed1988

Sternotomy closure with Parham bands.

The closure of a median sternotomy incision requires secure bony approximation to prevent postoperative pain, sternal click, and/or nonunion of bone. The standard technique of sternotomy closure involves the use of stainless steel wires for reapproximation of the sternum. These wires occasionally break or pull through bone, resulting in instability of either a portion of the sternum or the entire sternum. Presented here is our technique for sternotomy closure that provides secure closure with reduced postoperative morbidity.

Bone Wires↗
PubMed1987

Acute bowel entrapment and perforation following operative reduction of pelvic fracture.

The potential for multiple organ system injury with pelvic fracture is well known. This report illustrates a case whereby medially displaced acetabular fragments had become adherent to small bowel. Delayed posterior pelvic open reduction caused entrapment of this bowel within the fracture site followed by acute obstruction and perforation.

Accidents, Traffic↗
PubMed1986

Superoxide generation during cardiopulmonary bypass: is there a role for vitamin E?

The cytotoxic metabolites of oxygen [superoxide (O-2), hydrogen peroxide (H2O2), and hydroxyl (OH.)] have been demonstrated to be involved in the peroxidation of membrane lipids consequently altering membrane composition, morphology, and function. Of all the lines of defense adopted by living organisms against toxic oxygen free radicals, vitamin E is most effective in the prevention of membrane damage. Cardiopulmonary bypass (CPB) has been shown to activate complement and cause sequestration of leukocytes which can recruit, adhere, and stimulate release of cytotoxic oxygen radicals. A prospective study of 30 patients evaluated the effects of CPB with and without an exogenous free radical scavenger (Group I, N = 20, control) and (Group II, N = 10, vitamin E) on H2O2 (a marker of oxygen free radicals) malonaldehyde (a marker of lipid peroxidation), transpulmonary leukosequestration, and plasma levels of vitamins E and C. Group I showed a progressive increase in H2O2 during CPB from 65 +/- 6 to 130 +/- 11 micron/ml (P less than 0.0001); plasma vitamin E decreased from 15 +/- 3 to 6 +/- 1 mg/liter (P less than 0.0001) while vitamin C increased from 1.6 +/- .3 to 2.3 +/- .3 mg/dl (P less than 0.0001). Group II showed no significant increase in H2O2 (from 78 +/- 8 to 93 +/- 5 microns/ml) during CPB and a significant reduction in H2O2 levels compared to Group I (P less than 0.001); plasma vitamins E and C did not change significantly in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Ascorbic Acid↗