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Biomedical subjects

P Fundaró

Publications and source records attributed to P Fundaró.

8 recordsLinked to original sources
PubMed1995

Severe diastolic dysfunction after endoventriculoplasty.

Endoventriculoplasty with pericardial patch has been advocated to repair anteroseptal ventricular aneurysm, but not studies have reported the influence of this technique on diastolic left ventricular function. We have evaluated the changes on ventricular filling by means of pulsed Doppler recording of diastolic transmitral flow. Doppler analysis reveals three distinct spectral patterns: (1) normal, (2) inverted, and (3) restrictive. We have found an abrupt change from a preoperative normal to postoperative restrictive pattern in a significant minority of patients (8%) who underwent endoventriculoplasty. These patients had clinical and hemodynamic signs (New York Heart Association class, time from anterior myocardial infarction, left ventricular end-diastolic pressure, pulmonary hypertension, and mitral regurgitation) of severe impairment but no differences were found in ejection fraction, aneurysmal extension, or remote myocardial function. Moreover, after operation they had a satisfactory ejection fraction, a low end-diastolic volume, and an apex-base length shorter than the predicted value for a normal population. The presence of a postoperative restrictive pattern of diastolic filling is a strong predictor of 3-month mortality and makes the medical treatment difficult. Caution must be taken to perform endoventriculoplasty in patients who are severely ill, especially those recently affected by myocardial infarction. When the clinical conditions dictate the operation, a nonenthusiastic volume reduction seems to be a prudent option.

Coronary Aneurysm↗
PubMed1992

Correction of anterior mitral prolapse. Results of chordal transposition.

From 1986 to 1992 102 mitral valve repairs were done for mitral regurgitation due to a degenerative disease. Forty-eight patients had an anterior prolapse or prolapse of both leaflets at initial presentation and underwent chordal transposition from the mural leaflet to the anterior leaflet. The corrective procedure was completed by polytetrafluoroethylene or pericardial posterior annuloplasty. Operative mortality was 2.9%, and follow-up (average 22 months) was 100% complete. There were three postreconstruction valve replacements (one earlier and two later) for a probability of freedom from reoperation of 91.5% +/- 5.2% at 3 years. Freedom from all morbidity was 85.5% +/- 5.5% at 3 years. Postoperative echocardiographic studies demonstrated a good mitral valve function: (1) Eighty-seven percent of patients presented no or mild residual regurgitation; (2) transmitral flow indexes were within the norm; (3) left ventricular outflow tract flow was normal in all patients. This study shows that chordal transposition is a safe and effective technique for prolapse of anterior or both leaflets and improves the chances of repair in patients with mitral degenerative disease.

Adult↗
PubMed1991

Technical progress in coronary surgery.

This report reviews the most recent technical advances that improve the results of coronary artery bypass grafting and discusses advantages and limitations in revascularization by extensive employment of arterial grafts. There is evidence that the use of the second internal mammary artery for coronary grafting, in selected cases, gives excellent long-term results. The use of alternative arterial conduits in conjunction with both internal mammary arteries in order to achieve complete revascularization with arterial grafts only has yielded good short-term results. However, for late results further and larger studies are necessary. In diffuse coronary artery disease, complex vessel endarterectomy and reconstruction procedures are currently performed by several surgeons with low operative risk and good midterm clinical results. Favorable results concerning the patency of the endarterectomized coronary arteries and related grafts have been reported.

Coronary Artery Bypass↗