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R Pessotto

Publications and source records attributed to R Pessotto.

31 records · Page 2Linked to original sources
PubMed1997

Coronary translocation during aortic root replacement with the pulmonary autograft: complications and their management.

BACKGROUND AND AIMS OF THE STUDY: Aortic root replacement with the pulmonary autograft has become an alternative to replacement of the diseased aortic valve with mechanical or biological prostheses. Due to greater technical complexity of the operation, complications with autograft root replacement (ARR) may be more common. In particular, a higher prevalence of coronary complications has been suggested. METHODS: In order to assess the prevalence, cause and management of coronary complications after ARR, results with 26 consecutive operations were reviewed and compared with previously published series. Between July 1994 and Apri 1997, 22 males and four females (mean age 26 +/- 8 years; range: 11 to 36 years) underwent aortic root (n = 22) or valve replacement (n = 4) with a pulmonary autograft for regurgitation (n = 14), stenosis (n = 4) or both (n = 8). Associated lesions were present in 10 (38%) patients, including three cases of major coronary artery anomalies such as origin of the circumflex from the right coronary sinus, high origin of the right coronary, aneurysmal and calcified right and left main coronaries, both in one patient. RESULTS: There were no early deaths. Major complications occurred in six patients; re-exploration for bleeding was required in three (11%) and partial take down of repair for coronary complications in three (11%), all with preoperative coronary anomalies. Two of the latter patients presented with intraoperative right ventricular ischemia due to kinking of the right coronary (corrected by re-implantation at a higher level), and one had intraoperative hemorrhage due to rupture of a calcified left main coronary, which required transection of the pulmonary homograft above the valve to expose the tear. Recovery was prompt in all patients (mean ICU stay 35 +/- 28 h) with no metabolic or electrocardiographic evidence of ischemia. Echocardiography at discharge showed satisfactory biventricular kinetics in all; mild regurgitation of the autograft was found in two (8%) who had undergone subcoronary implant, and absent or trivial in 22 (92%). One patient died suddenly 13 months after ARR; hence actuarial survival rate was 100% and 96% at 12 and 24 months, respectively. At mean follow up of 15 +/- 11 months (range 1 to 32 months), all patients are in NYHA class I and have returned to school or prior employment. CONCLUSIONS: Complications with coronary artery translocation during ARR may be a definite risk, particularly in the presence of coronary anomalies. Prompt recognition and an aggressive intraoperative approach, including partial take down of the repair, may limit the morbidity of this complex surgical procedure.

Adolescent↗
PubMed1996

Accelerated aortic allograft fibrocalcification after right ventricular outflow tract reconstruction in pediatric patients: report of two cases.

Two cases are presented of accelerated aortic allograft fibrocalcification after right ventricular outflow tract (RVOT) reconstruction occurring within 2 months after surgery in a 5-year-old and 22-month-old. Potential determinants of early calcification, clinical management after implantation and surgical alternatives are discussed.

Aorta, Thoracic↗
PubMed1995

Systemic and pulmonary venous connections in visceral heterotaxy with asplenia. Diagnostic and surgical considerations based on seventy-two autopsied cases.

To facilitate the preoperative diagnosis and surgical management of visceral heterotaxy and asplenia, 72 postmortem cases were reviewed with particular attention focused on the systemic and pulmonary venous connections. The superior vena cava was bilateral in 51 cases (71%), but in 9 cases one of the superior venae cavae was partly or totally atretic. Patent bilateral superior venae cavae were found in 42 cases (58%) and the superior vena cava was unilateral in 21 (29%). Although the inferior vena cava was never interrupted, a prominent azygos vein was found in 6 cases (8%). Some hepatic veins drained separately from the inferior vena cava in 20 cases (28%). An intact coronary sinus was rare (2 cases, 3%). Anomalous pulmonary venous connection to a systemic vein was total in 42 (58%) of 72 and partial in 2 (3%) of 72, with obstruction in 24 (55%) of 44. Abnormal pulmonary artery branches (severe hypoplasia, localized stenosis, or discontinuity) were present in 21 (29%), and these obstructive arterial anomalies were associated with a significantly higher prevalence of anomalous pulmonary venous connection (p < 0.01) and of pulmonary venous obstruction (p < 0.01). Cardiac pulmonary venous connections were found in 28 (39%), with the pulmonary veins and the inferior vena cava entering the same atrium in 10 (36%) of 28.

Adolescent↗
PubMed1995

Myocardial revascularization using branches of the left internal mammary artery.

To increase the number of arterial grafts in patients with multivessel coronary disease, we have used branches of the left internal mammary artery (LIMA) as bypass grafts. From March 1990 to June 1993, 15 patients (13 males and 2 females) aged 38 to 65 years (mean 57 +/- 8), received a total of 30 LIMA branch anastomoses. The two terminal branches were used to perform a "Y" graft to the left anterior descending coronary artery territory in 13 patients. A pericardiophrenic branch was used in four cases. Five patients (33.3%) had complete myocardial revascularization using IMA only. There were neither early nor late deaths and all patients are free from angina at a mean follow-up of 20 months (6 to 45 months). However, early postoperative cardiac catheterization, performed in 12 patients (80%), revealed a 20% occlusion rate for each terminal branch and a 50% occlusion rate for the pericardiophrenic branch. Technically challenging due to the small diameter of the grafts, the terminal LIMA branches should be limited to selected patients when more conventional arterial or vein conduits are not available. More proximal branches have a higher occlusion rate and their use is not recommended.

Adult↗
PubMed1995

Successful repair of complete sternal cleft associated with congenital heart disease. Report of one case.

Total failure of sternal fusion without other developmental anomalies of the chest and abdominal wall is rare. We report on a 52-year-old man with a total cleft sternum associated exclusively with an ostium secundum type atrial septal defect, a large cono-ventricular septal defect and pulmonary stenosis, who underwent successful surgical repair of the congenital heart disease and of the sternal anomaly by direct approximation of the freshened sternal remnants to the midline without interposition of tissue graft or inert prosthesis. This technique should be considered and attempted first as a better surgical option even in adult patients.

Abnormalities, Multiple↗
PubMed1995

Use of oversized homografts for right ventricular outflow tract reconstruction in infants.

A surgical technique for reducing the size of large diameter homografts in order to make them suitable for right ventricular outflow reconstruction in infants was clinically introduced by us at the Department of Cardiac Surgery, University of Padova in 1990. The method consists of two longitudinal incisions along the oversized homograft root removing one cusp with the relevant part of the aortic annulus and aortic wall. The remaining, flat "bicuspid" homograft is closed into a tube again around a mandrel of appropriate size. Preliminary experiences with the first three patients were excellent and have already been reported. The current study includes five additional patients (two male, three female) ranging in age from 20 days to 11 months (mean 8.3 months) and in weight from 3.2 to 7.4 kg (mean 6.2 kg) who underwent right ventricular outflow tract reconstruction with this surgical technique. There were no operative deaths and no instances of valve related complications at a mean follow up of 18 months. Serial echocardiography showed mild homograft stenosis in one patient (15 mmHg) and mild regurgitation in another. Although a longer follow up is necessary to determine whether the durability of these surgically modified "bicuspid homografts" can match that of the intact valves, we believe that our technique represents a valuable therapeutic alternative at least in the short term to the use of synthetic grafts in infants when an appropriately small homograft is not available.

Bioprosthesis↗
PubMed1994

Cardiac myxoma of the tricuspid valve: description of a case and review of the literature.

Although myxomas are the most common cardiac neoplasms in the adult population, they are very rare in pediatric patients. Tricuspid valve myxomas are even more exceptional at all ages, with only 16 cases being reported in the literature. We describe the case of a 10-year-old boy with a myxoma of the tricuspid valve, who was successfully operated without valve replacement.

Child↗
PubMed1993

Mechanical support for decompression of the left ventricle in repair of ischemic cardiac rupture.

Acute cardiac rupture is often a lethal complication of transmural myocardial infarction. A case of successfully treated left ventricular free wall rupture is described. Preoperative hemodynamic stabilization was achieved by intraaortic balloon counterpulsation. A BioMedicus left ventricular assist device was used intraoperatively and postoperatively to obtain long-term intraventricular decompression to allow for suture repair of friable myocardium.

Aged↗
PubMed1993

Ball fracture with the 6120-model Starr-Edwards mitral valve prosthesis occurring late after implantation.

The Starr-Edwards (S-E) mitral valve, Model 6120, has been widely used in the last three decades. Fatty infiltration and subsequent damage of the silastic ball, a phenomenon termed ball variance, has been described only in the first generation aortic ball-valve prostheses, used until 1965. A case of partial ball fracture in a 6120-Model S-E mitral valve prosthesis, occurring 27 years after implantation and presenting with thromboembolism and progressive valve dysfunction, is described.

Follow-Up Studies↗
PubMedDate not supplied

Hypoplastic left heart syndrome with restrictive atrial septal defect and congenital pulmonary lymphangiectasis.

The presence of a restrictive atrial septal defect in hypoplastic left heart syndrome represents a surgical emergency and may negatively affect survival after operation. A neonate with such a disease association, requiring septectomy upon birth developed intractable respiratory failure due to congenital pulmonary lymphangiectasis. The therapeutic implications of this rare pathologic condition are discussed.

Fatal Outcome↗
PubMedDate not supplied

Extracardiac shunt for nitric oxide-resistant pulmonary hypertension.

An interatrial extracardiac shunt was used to manage severe postoperative pulmonary hypertension, refractory to inhaled nitric oxide, in an infant undergoing repair of ventricular septal defect. The rationale, technique, and potential applications of this method are discussed.

Administration, Inhalation↗