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Biomedical subjects

N Luciani

Publications and source records attributed to N Luciani.

45 records · Page 3Linked to original sources
PubMedDate not supplied

Surgical treatment of recurrence of an aneurysm of aberrant right subclavian artery.

A 52-year-old woman underwent incomplete resection of an aneurysm of the aberrant right subclavian artery. Three years later she was hospitalized because of a right superior mediastinal mass on the chest X-ray and a new angiography revealed dilatation of the remaining part of the aberrant right subclavian artery near its origin and involving the adjacent thoracic aorta and the distal aortic arch. At surgery, a left posterolateral thoracotomy in the fourth intercostal space was performed. Using deep hypothermia and circulatory arrest the aneurysm was excised and the aortic tract adjacent to the aneurysm was replaced with a Dacron prosthesis.

Aneurysm↗
PubMedDate not supplied

[Myocardial revascularization with the internal mammary artery. The indications, technics and results].

This report reviews 218 patients who underwent internal mammary artery (IMA) grafting alone or with vein graft between 1986-1989. Our experience with IMA started with a single attached graft for proximal left anterior descending lesions in young patients affected from stable angina. After that our indications became more extensive. One IMA was utilized in 209 cases, both two IMAs in the remaining 9. Sequential IMA graft was performed in 16 patients and free IMA graft in 8. There were 242 IMA anastomosis and 295 associated vein by-passes. The overall operative mortality was 2.3%. Perioperative complications include myocardial infarction in 3 (1.4%), reoperation for bleeding in 4 (1.8%) and sternal wound complication in 4 (1.8%). These results are comparable to those of patients having only saphenous vein by-pass during the same period. At the follow-up actuarial survival rate at 42 months was 94 1.8% and 90% of these patients were completely asymptomatic. We include that IMA grafting shows low operative risk and provide excellent short term results. Our findings and the high long term patency rate of this conduit encourage us to extend the indication to IMA and to perform those surgical techniques that make possible multiple mammary coronary anastomosis.

Angina Pectoris↗
PubMedDate not supplied

Valve replacement with the tilting disc Sorin prosthesis in patients with narrow aortic annulus.

The Authors summarize their 5-year experience of the clinical use of the Sorin tilting disc prosthesis in 40 patients (group A) with narrow aortic annulus, compared with a control group (group B: 116 patients) where a larger Sorin prosthesis was implanted. Follow-up lasted from 1 to 60 months, with a mean of 25.6 +/- 12.3 in group A and 20.4 +/- 11.9 in group B. Early and late mortality were low: 1/40 and 2/39 (2.5 and 5.1%) in group A and 4/116 and 9/112 (3.4 and 8.0%) in group B (p = NS): only two deaths, one in each group, were prosthesis-related. Actuarial survival was comparable: 91.2% (CL: 96.3-86.1%) in group A and 78.0% (CL: 87.6-68.4%) in group B, as were probability of being event-free and alive, non-reoperated and with few or no symptoms [group A: 61.7% (CL: 72.4-51.0%) and 77.4% (CL: 85.9-68.9%) respectively; group B: 78.8% (CL: 83.4-74.2%) and 61.1% (CL: 85.9-68.9%) respectively]. The Authors conclude that the Sorin tilting disc prosthesis is a reliable valve substitute in the narrow aortic annulus; they recommend that enlargement procedures should be confined only to patients with annulus size less than 19 mm.

Actuarial Analysis↗
PubMedDate not supplied

Surgical treatment of massive pulmonary embolism.

Surgical treatment of massive pulmonary embolism (PE) is usually performed in cases of contraindications to fibrinolysis (trauma and/or recent surgery). Additional indications for the embolectomy are either clinical (shock low cardiac output, cardiac arrest) or angiographic (occlusion of more than 80% of pulmonary arterial bed). Due to the emergency setting, PE is often diagnosed only on a clinical basis (10-30% of the cases). Embolectomy is usually performed using cardio-pulmonary bypass (CPB). Trendelenburg procedure can be indicated in desperate situations. No general agreement exists concerning the role of interruption of the inferior vena cava (IVC), in order to prevent PE recurrence. Usually, interruption of the IVC is performed in cases of contraindications to anticoagulant therapy or in presence of recurrence despite anticoagulation. Operative mortality ranges from 40 to 70%; there are no differences between the two surgical techniques and the major risk factor for death is the preoperative clinical status (shock, and/or cardiac arrest). Anticoagulant therapy affords a low incidence of recurrence.

Cardiopulmonary Bypass↗