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R Fattori

Publications and source records attributed to R Fattori.

At least 19 recordsLinked to original sources
PubMed2002

Traumatic injuries: imaging of thoracic injuries.

Chest trauma is one of the most important causes of death, in particular in individuals under the age of 40 years. The mortality rate for chest trauma, often related to motor vehicle accidents, is approximately 15.5%; it increases dramatically to 77% with associated shock and head injury (Glasgow scores of 3-4). The accurate diagnosis of pathologies consequent to blunt chest trauma depends on a complete knowledge of the different clinical and radiological manifestations. The first diagnostic approach is classically based on chest X-ray often carried out on supine position at the hospital admission. A CT study must then be performed in all chest trauma patients in whom there is even the smallest diagnostic doubt on plain film. In particular, spiral CT (SCT) assumes a fundamental role in the demonstration of mediastinal hemorrhage and direct signs of aortic lesions. At present, SCT is routinely part of a diagnostic evaluation which also includes scans of the brain and the abdomen in polytraumatized patients. Magnetic resonance is the ideal method for visualizing diaphragmatic lesions. Furthermore, recent reports have demonstrated the high diagnostic value of MR in evaluating aortic injuries. The purpose of this article is to review the most common radiological patterns related to chest trauma.

Accidents, Traffic↗
PubMed2001

Usefulness of transesophageal echocardiographic monitoring to improve the outcome of stent-graft treatment of thoracic aortic aneurysms.

The stent-graft procedure is becoming an alternative to surgery for treatment of many diseases of the descending thoracic aorta. This study evaluated the role of transesophageal echocardiography (TEE), used in combination with fluoroscopy and angiography, in monitoring the outcome of stent-graft placement. Twenty-two consecutive patients were submitted to stent-graft positioning in the descending aorta for various pathologies (7 patients had type B aortic dissections, 6 had thoracic aneurysms, 2 had thoraco-abdominal aneurysms, and 7 had post-traumatic aortic aneurysms). Before stent-graft deployment, TEE changed the proximal site of stent positioning initially identified by angiography in 33% of patients (5 of 15) with aortic aneurysms because of calcifications or atheromas that could interfere with stent adhesion to the aortic wall and that were not seen on angiography. In 28% of patients (2 of 7) with aortic dissection, TEE showed the guidewire in the false lumen, allowing an immediate repositioning. After stent-graft deployment, color Doppler TEE showed a perigraft leak in 7 patients, whereas angiography detected a perigraft leak in only 2 patients (p = 0.02). In 4 of these patients, further balloon expansions resulted in resolution of the leak. In the remaining 3 patients, additional stent-graft positioning was necessary. Considering the total patient cohort, TEE yielded relevant information, resulting in procedure changes in 59% (13 of 22). In conclusion, TEE provided additional information with respect to angiography in all phases of stent-graft treatment, improving immediate outcome and reducing complications.

Adult↗
PubMed2001

Fibrillin-1 (FBN1) gene frameshift mutations in Marfan patients: genotype-phenotype correlation.

Marfan syndrome (MFS) is a multisystemic disease associated with mutations in the fibrillin-1 gene. Most of the reported mutations are missense substitutions mainly affecting the epidermal growth factor (EGF)-like protein domain structure and the calcium-binding (cb) site. The aim of our study was to investigate the correlation between fibrillin-1 frameshift mutations and the clinical phenotype in patients affected by MFS. In 48 out of 66 Marfan patients a pathogenetic mutation was found. We detected novel mutations causing premature termination codon in exons 19, 37, 40 and 41 of four Italian patients. The first mutation in exon 19 (cbEGF #8 domain) results in a clinical phenotype involving mainly the skeletal and cardiovascular systems. Interestingly, we noticed that, while mutations in exons 37 and 41 (eight cysteine domains #4 and #5) are milder, the mutation in exon 40 (cbEGF #24 domain) is more severe and causes major cardiovascular involvement with thoracic and abdominal aortic aneurysms. It is noteworthy that the degree of the severity in the phenotype of one of our patients and another from the literature carrying a mutation in exon 41 could be explained with alterations in mRNA expression.

Adult↗
PubMed2001

Arrhythmogenic right ventricular dysplasia: cardiomyopathy current opinions on diagnostic and therapeutic aspects.

Right Ventricular Dysplasia constitutes a genetic cardiomyopathy characterized by fibrous-adipose substitution of the right and rarely of the left ventricular myocardium. This disorder is associated with ventricular arrhythmias ranging from frequent ventricular ectopic beats, nonsustained and sustained ventricular tachycardia of left bundle branch morphology and sudden death. Therefore, the syndrome has been labelled Arrhythmogenic RVD Cardiomyopathy. Diagnostic criteria, preliminary genetic data, and clinical manifestations are summarized and critical addressed, using data from the literature and from our own experience. The most important aspects of the ECG in this syndrome are reviewed and stressed with particular attention to initial versus advanced clinical subsets. The typical anatomical abnormalities and biopsy or pathology material are presented.

Arrhythmogenic Right Ventricular Dysplasia↗
PubMed2001

Intravenous coronary angiography using synchrotron radiation: technical description and preliminary results.

BACKGROUND: Standard coronary angiography requires an arterial access and catheters; intravenous coronary angiography may image coronary arteries noninvasively and without catheters. The aim of this study was the assessment of the diagnostic accuracy of intravenous coronary angiography validated by selective coronary angiography. METHODS: Seventy outpatients (80% males, mean age 62 +/- 8 years) underwent both standard and intravenous coronary angiography after a previous coronary intervention. Intravenous coronary angiography was performed within 6 weeks before or after selective coronary angiography. Two different projections were used to obtain 6-8 sequences per patient. Images were taken after injection of the contrast agent into the brachial vein or into the superior vena cava. During image acquisition, patients were moved through the scanning beam on a special chair. Thereafter, images were evaluated and compared to selective coronary angiograms for the following criteria: no stenosis, subsignificant stenosis (< 70%), significant stenosis (> or = 70%), and occlusion. RESULTS: One hundred eighty-seven target vessels were analyzed. In 50 target vessels one or more stents had been implanted. Seventeen target vessels were not analyzable due to inadequate image quality. The sensitivity of intravenous coronary angiography for the detection of lesions was 80% and the specificity was 95%. The sensitivity for the detection of significant lesions in the left anterior descending coronary artery was 84% (specificity 93%), in the left circumflex coronary artery 67% (specificity 90%), in the right coronary artery 85% (specificity 97%), and in bypass grafts 85% (specificity 97%). No complications were observed. CONCLUSIONS: Intravenous coronary angiography is efficacious and safe and allows quantification of lesions of the coronary arteries and of bypass vessels. Further advances in image processing are needed to improve sensitivity especially in the left circumflex coronary artery.

Contrast Media↗
PubMed2001

[Non-surgical treatment of aortic aneurysms and dissections: indications, strategies and outcome].

PURPOSE: The endovascular treatment of the thoracic aorta is an effective alternative to open surgical repair and offers a therapeutic option even to patients at high risk for surgery. Our experience in the treatment of different diseases of descending thoracic aorta is reported. MATERIAL AND METHODS: Between July 1997 and January 2001, 50 patients were selected for endovascular treatment: 36/50 patients presented high risk for conventional surgery. Six patients presented clinical and imaging features suggesting impending rupture and were treated on emergency basis. The stent-graft prosthesis was individually manufactured or selected on the basis of spiral CT or MRI measurements. RESULTS: Endovascular stent positioning and deployment was technically successful in 49 cases. In one patient the tortuosity of the aortic arch prevented graft deployment. Complete aneurysm exclusion was achieved in 48 cases as assessed by post-procedure angiography and TEE. One proximal endoleak was noted and surgical conversion was performed 40 days later. There were no intraoperative mortality or complications. One patient presented extension of dissection at the 8th postoperative day and required of surgical repair. CT scan showed an endoleak in 4 cases that sealed spontaneously in three cases while the fourth case was treated by graft extension. In the long term two secondary endoleak were observed (12 and 24 months after the procedure). CONCLUSIONS: Endovascular stent-graft repair provides a less invasive opportunity to patients affected by thoracic aortic disease. Careful cases selection is the first postulate for the efficacy and safety of the procedure.

Aortic Dissection↗
PubMed2000

Evolution of aortic dissection after surgical repair.

Patients after aortic dissection repair still have long-term unfavorable prognosis and need careful monitoring. The purpose of this study was to analyze the evolution of aortic dissection after surgical repair in correlation to anatomic changes emerging from systematic magnetic resonance imaging (MRI) follow-up. Between January 1992 and June 1998, 70 patients underwent surgery for type A aortic dissection. Fifty-eight patients were discharged from the hospital (17% operative mortality) and were followed by serial MRI for 12 to 90 months after surgery. In all, 436 postoperative MRI examinations were analyzed. In 13 patients (22.5%) no residual intimal flap was identified, whereas 45 patients (77.5%) presented with distal dissection, with a partial thrombosis of the false lumen in 24. The yearly aortic growth rate was maximum in the descending aortic segment (0.37 +/- 0.43 cm) and was significantly higher in the absence of thrombus in the false lumen (0.56 +/- 0.57 cm) (p <0.05). There were 4 sudden deaths, with documented aortic rupture in 2. Sixteen patients underwent reoperation for expanding aortic diameter. In all but 1 patient, a residual dissection was present (in 13 without any thrombosis of the false lumen). Close MRI follow-up in patients after dissection surgical repair can identify the progression of aortic pathology, providing effective prevention of aortic rupture and timely reoperation. Thrombosis of the false lumen appears to be a protective factor against aortic dilation.

Adult↗
PubMed2000

The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

CONTEXT: Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. OBJECTIVE: To assess the presentation, management, and outcomes of acute aortic dissection. DESIGN: Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. SETTING: The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. PARTICIPANTS: A total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection. MAIN OUTCOME MEASURES: Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. RESULTS: While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. CONCLUSIONS: Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.

Adult↗
PubMed2000

Aortic diseases--do we need MR techniques?

MR with its various imaging protocols including spin-echo MR-imaging, gradient MR imaging, flow-mapping and MR angiography is the ideal tool for noninvasive assessment of any kind of aortic diseases. The technique allows to image the aorta both in the thoracic cage and in the abdominal aspects better than any other tomographic image modality. With the capability of angiography after intravenous injection of gadolinium even the information previously only obtained from invasive catheter-based studies is now available within minutes after an intravenous injection. The overview manuscript compares various clinical settings of aortic diseases as assessed by various imaging modalities and highlights the capability of MR-imaging for aortic diseases both in the chronic and the acute clinical setting.

Aortic Dissection↗
PubMed2000

Delayed treatment of isthmic aortic rupture.

Traumatic rupture of the thoracic aorta is a life-threatening injury with a high mortality, and is difficult to manage in polytraumatized patients. Between 1980 and 1998, 50 patients were admitted to our Department with acute traumatic aortic rupture (TAR). The site of lesion was usually isthmic (86% of patients). From 1980 to 1992, 21 patients (Group I) underwent emergency surgical repair; from 1992 to January 1998, 29 patients (Group II) underwent intensive medical treatment, except one who was haemodynamically unstable and died 8h after the trauma from a massive haemothorax before an emergency thoracotomy could be attempted. The aortic rupture was followed up by MRI or CT scan. Twenty-one patients in Group II underwent aortic repair an average of 8.6 months after the injury. In two patients the operation was expedited because of an enlarging aortic aneurysm. In Group I the postoperative mortality was 19%, three patients developed postoperative paraplegia and one acute renal failure. In Group II there were no postoperative deaths and no major complications.

Adult↗
PubMed2000

Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography.

OBJECTIVES: Endovascular treatment of the thoracic aorta has developed as an efficacious alternative to open surgical repair. However, despite the high primary success rate, perigraft leakage constitutes the major concern in long-term follow-up. Endoleaks are widely reported both in abdominal and thoracic endovascular series and are usually identified by intraoperative angiography. Transesophageal echocardiography is a sensitive imaging technique in the evaluation of aortic diseases, widely used to monitor cardiac surgery. The aim of this study was to evaluate the efficacy of transesophageal echocardiography in leakage detection during endovascular stent procedures of the thoracic aorta. METHODS: Intraoperative transesophageal echocardiography was used in conjunction with angiography in 25 patients subjected to endovascular stent treatment of the descending thoracic aorta. Spiral computed tomographic scanning was performed before discharge and 3, 6, and 12 months after treatment. RESULTS: Information from transesophageal echocardiography was relevant in the selection of the landing zone in 62% of cases. In 8 patients, transesophageal echocardiography with color Doppler sonography showed a perigraft leak, 6 of which were not visible on angiography, suggesting the need for further balloon expansion or graft extension. Postoperative computed tomographic scanning in the 25 patients showed 1 endoleak, which sealed spontaneously. At 3 months, computed tomographic examination confirmed the absence of perigraft leakage in all patients. CONCLUSIONS: During implantation of a stent-graft in the descending thoracic aorta, transesophageal echocardiography provides information in addition to that provided by angiography, improving immediate and late procedural results.

Adult↗
PubMed2000

Magnetic resonance imaging evaluation of aortic elastic properties as early expression of Marfan syndrome.

In Marfan syndrome, early identification and treatment of aortic involvement could improve prognosis, but clinical diagnosis may be difficult at a young age, before aortic dilation occurs. The aim of this study was to evaluate biomechanical aortic properties in Marfan patients and in their relatives to identify an early index of aortic involvement. A magnetic resonance imaging (MRI) morphologic and functional study of the thoracic aorta was performed in 20 Marfan patients, 15 family members, and 14 healthy volunteers as a control group. The aorta was imaged in the oblique sagittal plane by spin-echo sequence. A high-resolution gradient-echo sequence was then applied in the axial plane at the level of ascending supravalvular aorta to evaluate aortic distensibility. Aortic distensibility (mm Hg(-1) was significantly different in the three groups (ANOVA, p = 0.0001). Aortic distensibility was sensibly reduced in Marfan patients (0.0085 +/- 0.006 vs. 0.025 +/- 0.006 control group, p < 0.05). No significant correlation was found between aortic area and distensibility. Aortic distensibility was reduced also in family members (0.016 +/- 0.011 vs. 0.025 +/- 0.006 control group, p < 0.05). Among them, 4 subjects showed aortic diameters to the upper limit of the normal range, whereas the other 11 presented normal aortic diameters. Intraobserver and interobserver reproducibility for diastolic measurement was 1.2% and 0.4%, respectively, and 1.1% and 0.3%, respectively, for systolic measurement. MRI is an accurate technique in detecting abnormal aortic elastic properties in Marfan patients. Abnormal ascending aorta distensibility may constitute an index of early aortic involvement before dilation occurs.

Adolescent↗
PubMed1999

Importance of dural ectasia in phenotypic assessment of Marfan's syndrome.

BACKGROUND: Early identification of Marfan's syndrome is fundamental in the prevention of aortic dilatation, but the wide phenotypic expression of the disorder makes the clinical diagnosis very difficult. Dural ectasia has been classified as a major diagnostic criterion; however, its prevalence is not known. We aimed to identify the true prevalence of dural ectasia in Marfan's syndrome, and to investigate its relation to aortic pathology. METHODS: A magnetic-resonance-imaging (MRI) study of the thoracic aorta and of the lumbosacral spine was done in an inclusive series of 83 patients with Marfan's syndrome to assess the presence and degree of dural ectasia and aortic involvement; 12 patients were younger than 18 years. 100 individuals who underwent MRI of the lumbar spine for routine clinical indications represented the control group; none of them had any potential causes for dural ectasia. FINDINGS: Dural ectasia was identified in 76 (92%) patients and none of the control group. The severity of dural ectasia was related to age; the mean (SD) age of patients with mild dural ectasia was 26 years (14) whereas that of those with severe disease (meningocele) was 36 years (9) (p=0.038). 11 of 12 patients younger than 18 years had dural ectasia. No association was found between aortic dilatation and dural ectasia. INTERPRETATION: Dural ectasia is a highly characteristic sign of Marfan's syndrome, even at an early age.

Adolescent↗
PubMed1999

Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.

BACKGROUND: The treatment of thoracic aortic dissection is guided by prognostic and anatomical information. Proximal dissection requires surgery, but the appropriate treatment of distal thoracic aortic dissection has not been determined, because surgery has failed to improve the prognosis. METHODS: We prospectively evaluated the safety and efficacy of elective transluminal endovascular stent-graft insertion in 12 consecutive patients with descending (type B) aortic dissection and compared the results with surgery in 12 matched controls. In all 24 patients, aortic dissection was diagnosed by magnetic resonance angiography. In each group, the dissection involved the aortic arch in 3 patients and the descending thoracic aorta in all 12 patients. With the patient under general anesthesia, either surgical resection was undertaken or a custom-designed endovascular stent-graft was placed by unilateral arteriotomy. RESULTS: Stent-graft placement resulted in no morbidity or mortality, whereas surgery for type B dissection was associated with four deaths (33 percent, P=0.09) and five serious adverse events (42 percent, P=0.04) within 12 months. Transluminal placement of the stent-graft prosthesis was successful in all patients, with no leakage; full expansion of the stents was ensured by balloon inflation at 2 to 3 atm. Sealing of the entry tear was monitored during the procedure by transesophageal ultrasonography and angiography, and thrombosis of the false lumen was confirmed in all 12 patients after a mean of three months by magnetic resonance imaging. There were no deaths or instances of paraplegia, stroke, embolization, side-branch occlusion, or infection in the stent-graft group; nine patients had postimplantation syndrome, with transient elevation of C-reactive protein levels and body temperature plus mild leukocytosis. All the patients who received stent-grafts recovered, as did seven patients who underwent surgery for type B dissection (58 percent) (P=0.04). CONCLUSIONS: These preliminary observations suggest that elective, nonsurgical insertion of an endovascular stent-graft is safe and efficacious in selected patients who have thoracic aortic dissection and for whom surgery is indicated. Endoluminal repair may be useful for interventional reconstruction of thoracic aortic dissection.

Adult↗
PubMed1999

MRI of acute and chronic aortic pathology: pre-operative and postoperative evaluation.

With recent advances in the understanding of aortic diseases, both power and versatility have put magnetic resonance imaging (MRI) in the focus of diagnostic work-up in the entire spectrum of clinical aortic pathology. Technical refinements, from classic anatomic imaging to three-dimensional gadolinium-enhanced MR angiography and tissue characterization, have rendered MRI ideal for assessment of acquired disease such as aortic dissection, intramural hematoma, and aneurysm, along with postoperative follow-up evaluation, with better reliability and safety than other imaging modalities. Moreover, congenital pathology of the aorta, including aortic arch anomalies and coarctation, can be non-invasively evaluated by MRI. With spectroscopy and the advent of high-resolution intravascular coils, MRI may even provide histopathologic and potentially prognostic information unparalleled by any other method. J. Magn. Reson. Imaging 1999;10:741-750.

Aorta, Thoracic↗
PubMed1999

Composite graft replacement of the ascending aorta: leakage detection with gadolinium-enhanced MR imaging.

PURPOSE: To assess the value of magnetic resonance (MR) imaging in the detection of postoperative complications after composite valve graft replacement. MATERIALS AND METHODS: Spin-echo and gradient-echo MR imaging was performed in 52 patients 1/2 to 200 months after composite graft replacement of the ascending aorta (22 for dissection, 30 for aneurysm). The prosthetic aortic segment, distal and proximal anastomoses, general morphologic characteristics, and diameter of the reimplanted coronary arteries were evaluated. In patients with abnormal perigraft thickening, additional spin-echo imaging was performed after injection of gadopentetate dimeglumine. RESULTS: Normal postoperative perigraft thickening (< or = 10 mm) was observed in 42 patients. Ten patients had abnormal periprosthetic thickening of 15-52 mm. Gadolinium-enhanced MR imaging demonstrated leakage in five of those 10 patients. The lack of enhancement excluded the presence of bleeding in the remaining five patients (three with chronic hematomas, one with infection, and one with granulation tissue). These findings were confirmed at surgery or with subsequent follow-up MR examinations. CONCLUSION: MR imaging was an optimal imaging modality for evaluating the morphologic characteristics of composite grafts and reimplanted coronary arteries. Gadolinium-enhanced MR imaging is a simple, accurate, and noninvasive method for detecting a leak, which necessitates urgent repeat surgery.

Aortic Dissection↗
PubMed1999

[Endovascular treatment in diseases of the thoracic aorta].

PURPOSE: To determine whether endovascular treatment of thoracic aorta conditions can be an effective alternative approach to surgical repair. MATERIAL AND METHODS: July 1997 to February 1999, eighteen patients (16 men and 2 women; 58.6 +/- 14.8 years) presenting with different kinds of descending aorta conditions were selected for the endovascular treatment. All patients exhibited severe comorbid pulmonary and/or cardiovascular medical conditions which increased surgical risk. All implants were performed in the operating room under fluoroscopic and TEE guidance. Clinical and imaging follow-up was performed 1, 3, 6 and 12 months later. RESULTS: The endovascular treatment was successful in 17 cases. No deaths or major complications occurred. No leakage was evident at post-procedure angiography. The patients were discharged after 6 +/- 4 days. MRI or CT study performed before hospital discharge showed aneurysms exclusion in 16 patients. In the four cases of dissection, thrombosis of the false lumen was evident since the first follow-up study. In the group of patients (11 cases) with 6 months follow-up, the diameters of stented aortic segments decreased. No late leakage was observed and thrombosis was complete in all cases. DISCUSSION: The natural history of aortic aneurysms and dissection is progressive toward dilation and aortic rupture. Surgery of descending thoracic aorta is burdened with a mortality of 8-12% in elective cases and over 50% in emergency cases or aortic dissection. The endovascular treatment of aortic conditions was introduced in clinical practice in 1991 and literature data show that it is effective, with lower mortality and morbidity rates than surgical treatment. CONCLUSION: Our results stress the feasibility and effectiveness of endovascular procedure in the treatment of complex thoracic aorta conditions even in high risk patients. Thus, endovascular treatment of thoracic aorta can be considered an effective alternative approach to conventional surgery.

Adult↗