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Biomedical subjects

R Calabrò

Publications and source records attributed to R Calabrò.

At least 91 records · Page 5Linked to original sources

[The contrast echocardiography for the diagnosis of the venous system anomalies. Echo-angiographic correlations (author's transl)].

Contrast echocardiography is described as an important technique for the diagnosis of the anomalies of the venous system. Six patients with intrahepatic interruption of the inferior vena cava (IVC), ten patients with persistent left superior vena cava (PLSVC) connecting to coronary sinus (CS), one patient with PLSVC connecting to left atrium (LA) and ten patients, control group, with normal venous connections were studied by two-dimensional echocardiography; the injections of dextrose were made into the left hand, right hand, leg; the locations of the transducer were: subcostal position, parasternal and suprasternal. All patients underwent cardiac catheterization and cineangiography. When the injection was made into a leg vein, in the patients with infrahepatic interruption of the IVC we observed the contrast medium descending from the superior vena cava into the right atrium (RA). In the cases with PLSVC connecting to CS, contrast medium injected into the left hand, the sequential clouding of CS, RA and right ventricle was seen. The pattern of opacification in the case of PLSVC connecting to LA is discussed. In conclusion, contrast echocardiographic study of the connections of the venous system may be useful in planning the way for cardiac catheterization and also for the diagnosis of some anomalies which might be mistaken even at the time of the hemodynamic study.

Cardiac Catheterization↗

[Enlarged coronary sinus. Mono and bidimensional echocardiographic aspects (author's transl)].

One case of enlarged coronary sinus with a total anomalous pulmonary venous connection (TAPVC) is described. The echocardiographic findings are compared to those seen in cases with persistence of the left superior vena cava (PLSVC). The diagnosis has been established by single crystal and two-dimensional echocardiography, by cardiac catheterization and angiography and was confirmed at surgery; post-operative echocardiographic control was performed. The differential diagnosis between TAPVC or PLSVC and other anomalies which may simulate a dilated coronary sinus is discussed. The differences between TAPVC and PLSVC by contrast echocardiography are reported.

Cardiac Catheterization↗

[Anatomical corrected malposition. Report of two new cases (author's transl)].

Two new cases of anatomically corrected malposition of great arteries (A-V concordance or discordance; V-GA concordance; subaortic conus) are reported. One of these has been studied from the autoptic specimen and is in situs solitus with A-V concordance (SDL), which is the most common form of such alteration. The second case, studied by angiography, is in situs inversus with A-V concordance (ILD). This form has been described only once in the literature, but some Authors still consider it "possible" such an anormally rather than reported as yet. Finally the anomalies most frequently associated to the MACGA and the possible morphogenesis are valuated.

Child↗

[Acute treatment with verapamil of paroxysmal supraventricular tachycardia and atrial flutter in paediatric age (author's transl)].

43 patients, 3 days to 12 years old, presented 68 paroxysms of supraventricular tachycardia and 2 crises of atrial flutter. 6 patients had a WPW syndrome and only 7 had an associated cardiac disease; the remaining had no other complaint but the arrhythmia. Verapamil, administered in the dose of 0.125-0.25 mg/Kg intravenously, interrupted critically the tachycardia in virtually all cases. The flutter was converted to atrial fibrillation with a slower ventricular rate. No adverse effects were observed but in two cases: one had a cardiac arrest promptly relieved and another a ventricular bradycardia corrected by atropine. Both cases had received an overdose of the drugs.

Age Factors↗

[Balloon catheter atrial septostomy via the umbilical vein].

The feasibility of atrial septostomy through the ombelical vein is discussed. The advantages and the pitfalls of this technique are examined. On the basis of our experience with 8 cases thus treated in the last year, it is concluded that a careful use of this technique in patients under six days of age is indicated.

Cardiac Catheterization↗

[A bloodless evaluation of the gradient of valvular and subvalvular aortic stenosis. Correlations with the hemodynamic picture. (author's transl)].

53 patients affected by congenital valvular or discrete aortic stenosis have been evaluated in order to compare the observed gradient with the one expected according to multifactorial analysis based on electrocardiographic and auscultatory data deviced by Ellison et al. There Authors employed this formula for the evaluation of the valvular form only. In our experience all cases of valvular stenosis showing an estimated gradient less than or equal to 40 mmHg were found to have a gradient less than or equal to 40 mmHg at the catheterization. This statement is true in the discrete form as well, only if the estimated gradient was less than or equal to 30 mmHg. The regression curve between the two gradients shows a r = 0.718 (p less than 0.01); an even better correlation was found in the valvular forms (r = 0.816; p less than 0.01). These results are very useful since they allow to restrict indication to catheterization only to the cases in which the obstruction is estimated to necessitate a surgical intervention.

Adolescent↗

[Polysplenia. Description of a case].

A clinical and hemodynamic study of a case of polysplenia, with typical left bilateral symmetry, anomalies of systemic venous drainage and defect of the endocardial cushions. A brief revision of the literature is given and the embriological and clinical concept of the left bilateral symmetry is discussed.

Adult↗

[The vectorcardiogram of Fallot's tetralogy in the first two years of life. Qualitative and quantitative analysis (author's transl)].

36 patients, less than two years old, affected by Fallot's tetralogy were studied by vectorcardiography. The configuration of the QRS loop in the three orthogonal planes, the voltage of the 0.10 sec spatial vector, RMSV and LMSV vectors, and their azimuth and elevation were evaluated. Such data have been correlated to arterial oxygen saturation. Qualitative analysis showed a clockwise or figure eight QRS loop on the H and F planes in the great majority of cases; and only in a counterclockwise loop on the H plane was the suspicion of an arterial oxygen saturation greater than 85% especially in cases older than two months. The terminal forces of the QRS loop on the H plane were always directed under the O point, Whereas in the valvular pulmonary stenosis, terminal forces are generally superior to the O point. Quantitative analysis demonstrated the constant increase of the RMSV and the direct relationship of the LMSV to arterial oxygen saturation, and so it was the principal parameter for evaluation of the left ventricular volume and the size of pulmonary flow and the degree of pulmonary stenosis. The relationship between the azimuth of 0.01 sec spatial vector to O2 saturation was highly significant, showing a progressive anterior development of the former, as the latter increased.

Age Factors↗

[The VCG in ventricular septal defect in the first two years of life. Qualitative and quantitative analyses (author's transl)].

A group of 37 patients, less than 2 years old, with a ventricular septal defect of variable degree, and a left to right shunt, were studied by vectorcardiography. The duration, the direction and the aspect of the QRS loop on the three orthogonal planes, the voltage of the 0.01; 0.02; 0.04 vectors, the right and the left maximum spatial vectors and their projection on the H and F planes were analyzed and correlated to the right ventricular systolic pressure and Qp/Qs. A clockwise or an eight-type loop on the frontal plane, regardless of RVSP, was observed; on the H plane the loop is, usually, counterclockwise when the pressure is low or medium, and can be of the eight-type but never clockwise when the pressure is systemic. Very interestingly, the quantitative analysis showed a consistent increase of the LMSV. A progressive relationship between the spatial vectors and the right ventricular pressure was noted. The diagnosis of combined ventricular hypertrophy depend upon the following findings: the majority of cases showed a large, counterclockwise and anterior QRS loop on the H with the maximum vector to the left and anteriorly; in all cases the 0.01; 0.02; 0.04 vectors were enlarged, thus warranting the diagnosis of combined ventricular hypertrophy in the first few months of life. 4 cases with low RVSP presented increased initial forces to the right and anteriorly directed, while the major portion of the loop was in the left posterior quadrant on the H plane, with a counterclockwise direction. In our view, the differential diagnosis between this type of aspect and that of diastolic overload of the left ventricle can rest only on the increased voltage of the 0,02 vector which means both systolic and diastolic overload of the right ventricle when accompanied by an increased 0.01 vector which indicates volume overload of left ventricle. Likewise only a quantitative analysis can help in differentiating a combined ventricular hypertrophy from a normal tracing in children under 6 months who show an eight-type loop on the H plane with initial and medium vectors directed anteriorly to the left and counterclockwise, and terminal vectors to the right, posteriorly and clockwise, or in those cases with an anterior clockwise loop on the H plane. Moreover, in the first month of life, the VCG of large VSD with increased pulmonary flux and pressure, can be differentiated from the normal by the QRS loop on the H plane which is clockwise, with initial vectors directed to the left and anteriorly with increased LMSV.

Age Factors↗

[The vectorcardiogram in A-V canal in the first three years of life: qualitative and quantitative analysis (author's transl)].

The electrocardiograms and the vectocardiograms of 26 childrens, up to 3 years of age, affected by A-V canal, were been analyzed. The pattern of QRS loop in the 3 planes, the voltage of right maximum spatial vector (RMSV) and left maximum spatial vector (LMSV), their projection onto the horizontal (azimuth) and frontal plane (elevation) were related to right ventricular systolic pressure. The qualitative and quantitative evaluation of VCG Showed a better correlation with the haemodynamic data than the electrocardiogram. In all but 3 cases, the high frequency of superior orientation and counterclockwise rotation of QRS loop in the frontal plane was found; moreover the good correlation of right ventricular systolic pressure to the rotation of QRS loop on the horizontal plane was also confirmed. In fact, the latter was counterclockwise in the cases with a low pressure, whereas it became clockwise in those with higher pressure. Moreover a good direct correlation of the right ventricular pressure with forward orientation of LMSV on the horizontal plane was found. In differential diagnoses with other congenital heart diseases with superior orientation and anticlockwise rotation on the frontal plane, useful results were obtained by using the calculation of elevation time (the interval between point 0 and intersection of the QRS loop with the axis) which is significantly lower in the A-V canal. Terminal forces directed posteriorly and to the right and with a delay no longer than 0,03 inches do not warrant the diagnosis of left anterior hemiblock with a right bundle branch block associated. On the contrary, on the basis of anatomical and electrophysiologic studies we believe that in this disease there is an asinchrony in the activation i.e. the postero-inferior region, then the left lateral wall and finally the tree high part of right ventricle wall are sequentially activated.

Age Factors↗