Biomedical subjects

P L DiGiorgi

Publications and source records attributed to P L DiGiorgi.

4 recordsLinked to original sources

PubMed2006

Comparison of Coapsys annuloplasty and internal reduction mitral annuloplasty in the randomized treatment of functional ischemic mitral regurgitation: impact on the left ventricle.

BACKGROUND: Functional mitral regurgitation is associated with both annular and ventricular distortion. Aggressive reduction annuloplasty for functional mitral regurgitation acts primarily at the annulus, with variable impact on the left ventricle. The Coapsys device externally reshapes the left ventricle to correct functional mitral regurgitation. Left ventricular reshaping was analyzed in a randomized study. METHODS: The RESTOR-MV study randomizes patients with coronary artery disease and functional mitral regurgitation to either reduction annuloplasty and coronary artery bypass grafting (the RA group) or Coapsys annuloplasty and bypass grafting (the CO group). The Coapsys device consists of epicardial pads connected by a cord. It was placed without cardiopulmonary bypass under echocardiographic guidance and sized to reduce annular dimension and improve leaflet coaptation. Internal reduction annuloplasty was performed by device placement. Intraoperative transesophageal echocardiograms were analyzed in 7 patients having reduction annuloplasty and 7 having Coapsys annuloplasty. RESULTS: Baseline mitral regurgitation (0-4 scale) was similar for the RA (3.0 +/- 0.6) and the CO groups (3.0 +/- 0.6). Intraoperative mitral regurgitation was reduced from 2.86 +/- 0.7 to 0.5 +/- 0.7 (P < .01 pre vs post) for the RA group and from 2.64 +/- 0.9 to 05 +/- 0.7 (P < .01 pre vs post) for the CO group. Annular anteroposterior diameter was reduced with both techniques: RA, 3.45 +/- 0.39 to 2.34 +/- 0.37 cm (P < .01 pre vs post); CO, 3.40 +/- 0.27 to 2.85 +/- 0.34 cm (P < .05 pre vs post). Long-axis dimensions were unchanged with both techniques. Short-axis dimensions measured at three levels were significantly reduced only in the CO patients: basal diameter 4.77 +/- 0.58 to 3.58 +/- 0.38 cm (P < .01 pre vs post); mid diameter 4.88 +/- 0.55 to 3.57 +/- 0.43 cm (P < .01 pre vs post); and apical diameter 4.39 +/- 0.46 to 3.38 +/- 0.34 cm (P < .01 pre vs post). CONCLUSIONS: Coapsys and reduction annuloplasty techniques both acutely reduce functional mitral regurgitation and annular dimension. The Coapsys device provided significantly greater left ventricular reshaping than did reduction annuloplasty. Further evaluation will assess the long-term valvular function and ventricular geometric stability associated with both techniques.

Aged↗

PubMed1994

Projections of individual Purkinje cells of identified zones in the flocculus to the vestibular and cerebellar nuclei in the rabbit.

The rabbit flocculus can be divided into five zones (zones 1, 2, 3, 4, and C2) with the use of acetylcholinesterase histochemistry. The projections of individual Purkinje cells in these zones to the vestibular and cerebellar nuclei were studied by using biocytin as an anterograde tracer. The zones were physiologically identified in terms of the Purkinje cell complex spike modulation occurring in response to optokinetic stimulation. In zones 1 and 3 neurons respond best to rotation about a horizontal axis that is close to perpendicular to the ipsilateral anterior semicircular canal, whereas in zones 2 and 4 neurons respond best to rotation about the vertical axis. Complex spike activity in zone C2 is unresponsive to optokinetic stimulation. Collectively, Purkinje cells of zone 1 projected to the ventral dentate nucleus, dorsal group y, and superior vestibular nucleus; Purkinje cells of zones 2 and 4 projected to the magnocellular and parvicellular parts of the medial vestibular nucleus; Purkinje cells of zone 3 projected to dorsal group y, ventral group y, and the superior vestibular nucleus; and Purkinje cells of zone C2 projected to the interposed posterior nucleus and dorsal group y. Some of the labeled Purkinje cell axons branched and innervated two nuclei. Branching axons from zone 1 either innervated both the ventral dentate nucleus and the superior vestibular nucleus or both dorsal group y and the superior vestibular nucleus. Branching axons from zones 2 and 4 innervated both the magnocellular and the parvicellular parts of the medial vestibular nucleus. Branching axons from zone 3 innervated both dorsal group y and the superior vestibular nucleus, or both ventral group y and the superior vestibular nucleus. Branching axons from zone C2 innervated both the interposed posterior nucleus and dorsal group y. Some of the target nuclei of the floccular Purkinje cell axons (e.g., dorsal group y and interposed posterior nucleus) project to the part of the inferior olive that, in turn, projects to the corresponding floccular zone, thus completing a closed pathway consisting of the inferior olive, the cerebellar cortex, and the cerebellar and vestibular nuclei. Other target nuclei (e.g., superior vestibular nucleus and medial vestibular nucleus) do not project back to the olivary subnuclei that innervate the flocculus and are part of an open olivofloccular pathway. An individual Purkinje cell thus can innervate a nucleus in the closed pathway as well as a nucleus in the open pathway.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed1994

Projections of individual Purkinje cells of identified zones in the ventral nodulus to the vestibular and cerebellar nuclei in the rabbit.

The projections of Purkinje cells from zones in the ventral nodulus of pigmented rabbits were studied with the use of extracellularly injected biocytin as an anterograde tracer. The zones were physiologically identified according to the complex spike modulation of Purkinje cells in response to optokinetic stimulation. Purkinje cells in the most medial zone do not respond to optokinetic stimulation; they project to the fastigial nucleus, the perifastigial white matter, the periinterposed white matter, and the medial vestibular nucleus. In the adjacent zone, Purkinje cells respond best to optokinetic stimulation about the vertical axis; they project to the periinterposed white matter and the medial vestibular nucleus. Purkinje cells in the next zone respond best to optokinetic stimulation about an axis approximately perpendicular to the ipsilateral anterior canal; they project to the periinterposed white matter, dorsal group y, the superior vestibular nucleus, and the medial vestibular nucleus. In the most lateral zone, Purkinje cells respond best to optokinetic stimulation about the vertical axis; they project to the periinterposed white matter, dorsal group y, and the medial vestibular nucleus. The majority of axons gave off collaterals and innervated more than one nucleus. Often, three or four different areas received terminals from a single Purkinje cell axon. The zonal projection pattern of the ventral nodulus is compared to that of the flocculus, which, with respect to the visual climbing fiber afferents, has similar zones.

Animals↗

PubMedDate not supplied

Current options for mechanical heart technology.

Heart transplantation remains the treatment of choice for end-stage heart failure despite limited donor availability and allograft durability. Artificial heart technology was initially developed as a replacement for transplantation but the initial experience with these technologies was disappointing. The quest for a total artificial heart has largely been abandoned in favor of ventricular assist devices (VADs). VADs have gained widespread acceptance as bridge to transplant and bridge to recovery therapy. After more than a decade of clinical use, several FDA approved device designs have proved effective in treating patients with various causes of heart failure. This review describes the current, clinically available ventricular replacement and assist devices and defines the adult patient populations in which they are useful. The next generation of these devices will soon become available and their clinical utility will likely shape the future direction of heart failure therapy. Ultimately the concept of a long-term total artificial heart may be revisited.

Device Approval↗