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Biomedical subjects

S Giannico

Publications and source records attributed to S Giannico.

At least 37 records · Page 2Linked to original sources
PubMed1990

Percutaneous balloon valvuloplasty of pulmonary valve stenosis, dysplasia, and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum: long-term results.

Eight-six children (aged 20 days to 14 years, 20 under age 1 year) underwent 94 percutaneous balloon valvuloplasty for pulmonary valve stenosis. The patients were divided into three groups: typical pulmonary valve stenosis (71), pulmonary valve dysplasia (9), and residual stenosis after surgical valvotomy for pulmonary atresia with intact ventricular septum (PAIS) (6). Each of the three groups was divided into two subgroups. In the early cases, balloon catheters with diameter 10-20% exceeding pulmonary valve annulus were used and the drop of the gradient was 39.5%. In the later cases, balloon diameters 30-40% greater than the valve anulus or double balloons were used and a drop of 66.7% in the RV-PA pressure gradient was achieved. The dilation in patients with dysplastic valve and residual stenosis after surgical valvotomy for PAIS was less effective. Doppler echocardiography was the technique used to evaluate residual gradient. Six months to 4 years follow-up demonstrated a persistent decrease of the valve gradient.

Adolescent↗
PubMed1990

Total anomalous pulmonary venous connection: surgical repair with a double-patch technique.

A double-patch technique has been used to repair total anomalous pulmonary venous connection in 35 patients (mean age, 4.9 months; mean weight, 4.2 kg). In all patients with supracardiac or subdiaphragmatic type of total anomalous pulmonary venous connection, repair has been accomplished by enlarging the "new" left atrium. There were three early deaths (3 of 35 = 8.6%) and no late deaths in a mean follow-up of 30 months (3 to 71 months). We propose this double-patch technique as an alternative surgical option for total anomalous pulmonary venous connection.

Anastomosis, Surgical↗
PubMed1990

Rehabilitation of children after total correction of tetralogy of Fallot.

Nine children who had undergone total correction of tetralogy of Fallot were studied with the purpose of observing the physical changes that might be produced by a period of rehabilitation in hospital and comparing these results with those of a control group having the same pathology but which had not followed a protocol for physical activity. Precise criteria were used in the selection of the patients. Careful clinical examinations and exercise tests were conducted before and after the programme, in particular maximal stress testing on the bicycle ergometer and submaximal exercise on the treadmill. The sessions were held three times weekly in a gymnasium over three months, gradually increasing the duration of each session to a maximum of one hour. During the session, heart rate was monitored with a Sport-tester 3000 so as not to exceed 60%, then 70%, of the maximal heart rate recorded during the stress test. Testing at the end of the programme demonstrated an improvement in tolerance under maximal stress in 7 of the 9 patients. As for submaximal performance, 8 out of 9 children covered a greater distance using the same parameters as for initial testing. At the end of the programme, the children all showed increased independence and initiative and more self-confidence in establishing social relations. The programme has proven to be a comprehensive method for safely improving physical fitness in these patients and represents an important starting point for a better future.

Child↗
PubMed1990

Systemic atrioventricular conduit for extracardiac bypass of hypoplastic systemic atrioventricular valve.

The management of severe congenital mitral stenosis in infants and children is still controversial. We describe our experience with the use of a systemic atrioventricular (SAV) extracardiac conduit to bypass a hypoplastic systemic atrioventricular valve. An SAV extracardiac conduit has been used in six patients (left atrium--left ventricle in five, right atrium--right ventricle in one). One hospital death occurred due to mediastinitis and there were two late deaths, one due to progressive subaortic stenosis and one sudden, possibly due to arrhythmia. Postoperative cardiac catheterization performed in five patients showed reduction of the transmitral gradient from a mean of 16 mmHg to a mean of 5 mmHg. Calcification of the bioprosthetic valve occurred in two patients 3 1/2 years and 2 years respectively after the operation; one died from concomitant subaortic stenosis and one underwent conduit replacement. Although its long-term efficacy is limited, the SAV conduit seems the most reliable surgical option for infants and children with hypoplastic systemic atrioventricular valves unsuited to conventional surgery.

Aortic Coarctation↗
PubMed1990

Pediatric cardiac surgery guided by echocardiography. Established indications and new trends.

Cardiac surgery in 602 children was not preceded by cardiac catheterization, the diagnosis being based on clinical findings and two-dimensional and Doppler echocardiography. In the 355 operations without cardiopulmonary bypass there were nine major and seven minor diagnostic errors (2.5% and 2%). Among the 247 cases with open-heart surgery there were no major and eight (3.2%) minor errors. The malformations most suitable for nonbypass surgery without catheterization seem to be those with reduced pulmonary blood flow requiring systemic-pulmonary artery shunt, aortic coarctation and patent ductus arteriosus. For open-heart surgery without invasive investigation, atrial septal defect, partial atrioventricular canal, aortic and pulmonary stenosis, cardiac tumor and isolated valve disorder are 'classic' candidates. Recent experience indicated that selected cases of complete atrioventricular canal, tetralogy of Fallot, truncus arteriosus, total anomalous pulmonary venous connection and transposition of the great arteries may safely undergo primary repair without cardiac catheterization. Because of its diagnostic potentialities, pediatric cardiac surgeons must become familiar with echocardiography.

Cardiac Catheterization↗
PubMed1990

Inferior vena cava-pulmonary artery extracardiac conduit. A new form of right heart bypass.

From November 1988 to May 1989, four patients underwent total right heart bypass by means of bidirectional cavopulmonary anastomosis and interposition of an extracardiac conduit from the inferior vena cava to the pulmonary artery. All of them had an uneventful postoperative course, and there have been no early or late deaths. We propose this technique as an alternative surgical option in candidates for a Fontan procedure with (1) hypoplasia or atresia of the left atrioventricular valve, (2) common atrioventricular valve, (3) anomalies of systemic and pulmonary venous return, or (4) auricular juxtaposition.

Arteriovenous Shunt, Surgical↗
PubMed1990

Airway obstructions associated with congenital heart disease in infancy.

Significant airway obstruction may complicate the natural and surgical history of infants with congenital heart diseases. Airway obstruction occurred in 12 infants who had operations for congenital heart disease. In all cases tracheography demonstrated the cause of airway obstruction. Significant mortality (5/12, 41.7%) and morbidity in this group of infants were the result of airway obstruction. To reduce the complications caused by airway obstruction in infants with congenital heart disease, we recommend (1) preoperative identification of patients with potential airway obstruction, (2) preoperative tracheography in high-risk infants, (3) appropriate choice of the surgical procedure, especially when insertion of a prosthetic conduit is required, (4) early recognition of the problem during the postoperative period, (5) prompt diagnosis by postoperative tracheography, with or without angiography, and (6) therapy directed at the cause of airway obstruction.

Airway Obstruction↗
PubMed1989

Palliation of complex cardiac anomalies with subaortic obstruction: new operative approach.

The modified Fontan operation for complex cardiac anomalies associated with subaortic obstruction entails a high surgical risk. It is likely that ventricular hypertrophy secondary to chronic pressure overload plays a significant role. This problem was approached with a new type of palliative operation comprising both a proximal pulmonary artery to ascending aorta anastomosis and a bidirectional cavopulmonary anastomosis. This operation was performed in six children ranging in age from 26 to 63 months. There was one intraoperative death due to hemorrhage. In one patient, a pulmonary to aorta conduit caused compression of the right coronary artery; the problem was solved by lengthening the conduit with a second period of cardiopulmonary bypass. The five survivors experienced an uneventful postoperative course. Repeat cardiac catheterization in these five patients showed low pressure in the cavopulmonary system (mean 10 mm Hg), absence of a gradient at rest between the systemic ventricle and aorta and fair arterial oxygenation (mean 82%). A technetium-99m perfusion lung scan visualized a slight prevalence of pulmonary blood flow ipsilateral to the shunt in three cases, whereas in one case preferential flow to the right lung was associated with a narrowing at the site of the cavopulmonary anastomosis. Mild hypoperfusion of the anterior pulmonary segments was observed in two cases. Both pressure and volume overload are abolished with this procedure and a satisfactory oxygenation is provided. Low venous pressure in the coronary, hepatic and renal areas as well as the short bypass time may explain the smoothness of the postoperative course in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1989

Tricuspid valve avulsion or excision for right ventricular decompression in pulmonary atresia with intact ventricular septum.

Retrograde right ventricular decompression through the tricuspid valve, by damaging or excising the valve, was attempted in five patients with pulmonary atresia, intact ventricular septum, and severely hypoplastic right ventricle. Two patients were neonates in critical condition, one of whom had received previous palliation with a shunt; the other neonate had received pulmonary valvotomy plus shunt followed by repeat valvotomy plus shunt ligation. Three patients were infants or children who had undergone placement of isolated neonatal shunts. One procedure was performed during cardiac catheterization. Three patients survived. In one, tricuspid avulsion and a Rashkind septostomy were done by percutaneous methods; in two patients, tricuspid excision plus bidirectional cavopulmonary anastomosis was done by open operation. At restudy, all showed subsystemic pressure in the right ventricle and diminution or disappearance of sinusoids. One also showed improvement of left ventricular function. Incorporation of a small right ventricle in the right atrium at the time of the two orthoterminal palliations seemed, at least, innocuous. Right ventricular decompression by tricuspid avulsion or excision could be suggested for all patients with pulmonary atresia, intact ventricular septum, hypersystemic hypoplastic right ventricle, and major sinusoids without right ventricular dependent coronary circulation in whom the outlet portion of the right ventricle is not functional.

Child, Preschool↗
PubMed1988

Long-term results after extracardiac valved conduits implanted for complex congenital heart disease.

Between August 1982 and December 1986, 56 patients survived implantation of an extracardiac valved conduit for complex congenital heart disease. The mean age at operation was 4.2 years (16 days to 24 yrs) and the mean weight was 15.9 kg (2.4 to 93.0 kg). The diagnosis was pulmonary atresia (PA) with ventricular septal defect (VSD) in 13 patients, tetralogy of Fallot in 11, transposition of the great arteries (TGA) with VSD in 8, truncus arteriosus, in 7, complex left ventricular outflow tract obstruction (LVOTO) in 6, complex left atrioventricular valve obstruction in 4, double outlet right ventricle with VSD and subaortic obstruction in 3, univentricular heart with pulmonary stenosis in 2, TGA with LVOTO in 1, and PA with intact ventricular septum in 1. In 35 patients, a preclotted conventional Dacron conduit (CDC) with bioprosthetic valve was used, in 19 patients a collagen-sealed Tascon valved conduit (TC) was implanted, and in 1 patient an aortic homograft was used. In a mean follow-up of 32.5 months (9 to 64 mo), there were two deaths (2/56, 3.6%) that were not related to the conduit. All survivors have been evaluated by two-dimensional and Doppler echocardiography, and 29/56 (51.8%) underwent cardiac catheterization. Nine patients (9/56, 16.1%) underwent successful valved conduit replacement, in seven cases with a nonvalved conduit. There was a significant difference (P = .011) with regard to the incidence of conduit replacement between the group with CDC (2/36, 5.5%) and the group with TC (7/19, 36.8%). Five patients underwent percutaneous transluminal balloon dilatation of the prosthetic conduit, with adequate relief of the gradient in four patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Balloon occlusion of the carotid artery for the angiographic visualization of Blalock-Taussig shunts and pulmonary arteries.

We describe the use of a balloon catheter to occlude the right or left carotid artery as a way of directing contrast material to the pulmonary arteries. This procedure was carried out in the postoperative study of 14 children who had undergone a Blalock-Taussig shunt. The method was reliable, and the angiograms provided excellent visualization of the pulmonary arteries using only small volumes of contrast material.

Anastomosis, Surgical↗
PubMed1988

[Diagnostic and therapeutic approach to lung neoplasms. Departmental experience at the Mestre Hospital].

The results are reported of a multidisciplinary diagnostic and therapeutic program applied to 381 patients with lung carcinoma from 1983 through 1985 at Mestre General Hospital. Cytologic and/or histologic diagnosis was established in 95% and staging accomplished in 96% of the patients. One-hundred-twenty-nine patients with non-small cell cancer were primarily treated by surgery (lobectomy or pneumonectomy); 3-year survival of this group was 48%. Of the 45 patients with pN1 or pN2 disease, 23 were treated with postoperative adjunctive mediastinal radiotherapy (50Gy/25 F/5Wk); however, survival showed no significant difference in the two groups. Ninety-seven inoperable patients were treated by radiotherapy alone; among those receiving doses of 50-60 Gy in 5 to 6 weeks, 3-year survival was 10%. Chemotherapy (CAMP), used in 23 cases (22 stage IV, 1 stage III), showed no improvement in survival, as compared with a similar series of patients submitted to symptomatic treatment alone. Of the 27 patients affected by small-cell carcinoma, 14 were treated with an aggressive radiochemotherapy protocol and 13 with palliative radiotherapy or low-dose chemotherapy: median survival in the two groups was respectively 45 and 60 weeks. Our study demonstrates the clinical feasibility of interdisciplinary programs routinely applied to a large population of lung cancer patients, and confirms its rationale in terms of early diagnosis, improved staging, and adequate treatment.

Adenocarcinoma↗
PubMed1987

[Reduction in transparency of the airway tracheogram, a sign of upper mediastinal pathology].

Some cases of mediastinal pathology in which the only pathological pattern was a "dimness" of the tracheal transparency are described. This sign is not described in previous reports and is described as a short break in the aerial tracheogram as seen on the frontal roentgenograph. This sign is produced by an increase in the structures outside the trachea or by a decrease in the air column inside the trachea. Conventional and CT anatomic findings which account for the sign are discussed. A short review of the "normal" causes of tracheal dimness is presented. This sign may be useful especially in emergency radiology, since it provides additional information to a simple routine chest roentgenograph.

Emergencies↗
PubMed1986

Two-dimensional echocardiographic anatomy in crisscross heart.

The anatomy of crisscross heart was studied in 14 patients, aged 2 days to 26 years, using 2-dimensional (2-D) echocardiography. The visceroatrial situs was solitus in all 14 patients. Crossing of the atrioventricular (AV) valves could be seen in each case by scanning in a subxiphoid or apical 4-chamber view. The subpulmonary infundibulum was deficient in 13 of the 14 patients, resulting in approximation of the pulmonary and tricuspid valves. Subpulmonary stenosis, seen in 11 patients, resulted from proximity of the infundibular septum, the tricuspid valve and the subpulmonary infundibular free wall. A subaortic infundibulum, present in all cases, was well developed in 13 patients, who had malposition of the great arteries, and was short in 1 patient, with nearly normally related great arteries. In cases that conformed to the inverse loop rule (segmental combination (S,D,L) or (S,L,D)), the pulmonary valve was posterior to the tricuspid valve and wedged between the AV valves. In 3 patients (double outlet right ventricle (S,D,L)) the mitral valve straddled into a large, left-sided subaortic infundibulum. In both patients with arterial malposition who did not follow the inverse loop rule, the pulmonary trunk was anterior to the tricuspid valve and well separated from the mitral valve. In patients with crisscross heart the ventricles appeared to have been rotated about their long axes without concomitant motion of the AV valve anuli, producing actual crossing of the ventricular inflow tracts. The right ventricular sinus was significantly smaller and the infundibulum significantly larger in the patients with crisscross heart than in age-matched control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

The hypoplastic mitral valve. When should a left atrial-left ventricular extracardiac valved conduit be used?

Limited experimental and clinical experience with extracardiac bypass of the mitral valve has been reported. We describe the case history of a 3-year-old child in whom a left atrial-left ventricular valved conduit was successfully used to bypass a severely hypoplastic parachute mitral valve. The potential applications of this unconventional surgical option are reviewed.

Angiocardiography↗
PubMed1985

Complete transposition of the great arteries: visualization of left and right outflow tract obstruction by oblique subcostal two-dimensional echocardiography.

Subcostal oblique 2-dimensional echocardiography was performed in 64 infants younger than 2 years with complete transposition of the great arteries (TGA) (situs solitus, concordant atrioventricular and discordant ventriculoarterial connections). All patients examined before cardiac catheterization had a correct diagnosis by 2-dimensional echocardiography using the subcostal oblique views. Twelve patients had associated left ventricular (LV) outflow tract obstruction and 7 had right ventricular (RV) outflow obstruction. The standard parasternal views failed to diagnose obstruction in 1 patients with LV outflow obstruction and 5 with RV outflow obstruction; the subcostal left oblique cut and long axis of the left ventricle visualized all left-sided obstructions, and right-sided obstructions were correctly displayed in 5 of 7 cases using a combination of left oblique and right oblique cuts. Two-dimensional echocardiographic subcostal oblique views allow an excellent definition of the morphologic characteristics of RV and LV outflow tracts in patients with TGA and improve the diagnosis of the outflow obstruction in these malformations.

Child, Preschool↗