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Biomedical subjects

S Pelenghi

Publications and source records attributed to S Pelenghi.

11 recordsLinked to original sources
PubMed2000

Congenital intrapericardial aneurysm of the left atrial appendage.

Congenital aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. It represents a diagnostic dilemma in patients with cardiomegaly and is commonly associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe the diagnostic evaluation and surgical treatment during 1997 of a patient with congenital aneurysmal dilatation of the left atrial appendage. The patient was discharged previously from our hospital in 1967 with the diagnosis of congenital dilatation of the pulmonary artery.

Child↗
PubMed1999

Assessment of CABG-related risk in patients with CAD and LVD. Contribution of PET with [18F]FDG to the assessment of myocardial viability.

BACKGROUND: Previous studies have demonstrated that hibernating myocardium can be assessed by [18F]fluorodeoxyglucose ([18F]FDG) and positron emission tomography (PET). This study evaluated the use of [18F]FDG-PET for CABG related risk assessment in patients with coronary artery disease (CAD) and left ventricle dysfunction (LVD). METHODS: We retrospectively evaluated 241 to patients candidate CABG presenting with signs and symptoms of congestive heart failure (CHF) prevailing over ischemic signs. Of the 241 patients, 153 had undergone [18F]FDG-PET as well as conventional assessment: 110 out of 153 (group A) were operated because of PET evidence of hibernation. Of the 241 patients, 88 had not undergone [18F]FDG-PET: 86 out of 88 (group B) were operated on. The outcome of surgical patients was evaluated by considering all major perioperative complications including the use of mechanical and pharmacological support and in-hospital mortality. After hospital discharge, each patient was examined at 1, 4 and every 6 months thereafter. RESULTS: Perioperative use of mechanical supports and inotropic drugs, was significantly lower for the PET selected group (A) than for the non PET selected group (B). Mortality within 30 days of surgery was 0.9% in group A and 19.8% in group B. The only predictors of perioperative outcome were the presence of hibernating tissue and the ejection fraction. CONCLUSIONS: [18F]FDG-PET prior to CABG can be crucial for the assessment of perioperative risk in patients with CAD.

Coronary Artery Bypass↗
PubMed1998

Mycotic aortic aneurysm presenting as multiple cerebral abscesses.

A 68-year-old male presented with multiple cerebral abscesses. Possible intrathoracic embolic sources were not detected by echocardiography and chest radiography and the main lesion was surgically excised. Following deterioration of the neurological status, computerized tomography performed 2 weeks later revealed a mycotic aneurysm of the ascending aorta, probably related to a previous cardiac operation. This is the first case in the literature of aortic infection presenting as multiple brain abscesses.

Aged↗
PubMed1998

Surgery of cavo-atrial renal carcinoma employing circulatory arrest: immediate and mid-term results.

From 1990 to 1995, 12 patients with cavo-atrial renal cell carcinoma underwent resection of the tumor. Circulatory arrest was employed in 11/12 cases. The neoplasm extended to the inferior vena cava in two patients and to the intrahepatic veins or right atrium in five cases. Two severely cardiac compromised patients died perioperatively. Of five patients who showed preoperative suspicion of isolated metastases, 3 patients died postoperatively because of relapsing disease after a mean period of 10.8 months. Five patients are alive and doing well after a mean follow-up of 14.8 months. In our experience myocardial dysfunction determined poor immediate survival. Mid-term survival was influenced by preoperative metastases and lymph-node involvement, but not by intracaval extension. Circulatory arrest appears to be a relatively safe technique to remove renal carcinoma with cavo-atrial extension and should be indicated whenever there are no metastases.

Adult↗
PubMed1998

Combined carotid and cardiac procedures: improved results and surgical approach.

Severe cerebrovascular complications following cardiac surgical procedures remain a major concern, particularly in patients with significant carotid atherosclerotic involvement (14% of perioperative stroke). Operative mortality for carotid operations in patients with documented Coronary Artery Disease (CAD) may be as high as 20%. Seventy patients underwent combined operations (unilateral carotid stenosis > 70%, unilateral stenosis > 50% with ulcerated plaque or bilateral stenoses > 50%; and this also included patients with unilateral occlusion). Cardiac procedures were 69 coronary artery bypass grafts, four left ventricular aneurysmectomies, three aortic valve replacements and surgery on two mitral valves. Seven perioperative deaths occurred, which were all caused by cardiac events. There were no perioperative strokes. Carotid endarterectomy immediately before cardiopulmonary bypass is a safe and expeditious approach to coexisting significant cardiac and carotid disease. In our experience, technical details in monitoring and minimizing cerebral ischemia are possibly more crucial in these severe vasculopathic patients. Moreover, it is probably advantageous from an economic standpoint compared with other therapeutic treatments.

Aged↗
PubMed1997

Aortic diverticulum without vascular ring: a rare cause of dysphagia.

In an adult with severe dysphagia, diagnosis of aneurysmal aberrant subclavian artery was suspected on computed tomogram; no vascular ring was visible on arteriogram. A diverticulum of the aortic isthmus was surgically resected. Histologic analysis ruled out acquired disease. In conclusion, dysphagia related to esophageal compression may be caused by an isolated congenital aortic diverticulum.

Aorta, Thoracic↗
PubMed1994

[Myocardial revascularization in patients with impaired left ventricular function].

From March 1988 to May 1993, 1,125 patients with coronary artery disease (CAD) underwent coronary surgery at our Institute. In the same period 74 patients (mean age 59 +/- 7 years; range 36-73) with left ventricular dysfunction (LVD) were referred for surgical decision making. All patients underwent [99mTc]MIBI/SPET to assess perfusion at rest and [99mTc]MIBI first pass radionuclide angiography to assess the ejection fraction (EF). In 44/74 patients we performed [18F]FDG/PET in fasting conditions and pharmacologic wash-out, in order to identify viable myocardium. We divided patients with LVD into 3 groups: Group A (30 patients) operated on without preoperative [18F]FDG/PET, Group B (37 patients) operated on with FDG uptake in segments with wall motion abnormalities, and Group C (7 patients) with no FDG uptake, who were excluded from coronary surgery; there was no significant difference among the 3 groups with respect to age, sex, CAD, risk factors and EF (Group A: 29.1% +/- 6.6%, range 16-39%; Group B: 30.8 +/- 5.6%, range 20-40%; Group C: 26.5 +/- 6.8%, range 18-37%). The study of perfusion and EF was repeated 6 months postoperatively in Group A and B. Left ventricular end-dyastolic pressure at cardiac catheterization was 19.9 +/- 5.1 mmHg, 20.4 +/- 4.7 mmHg and 26.8 +/- 9.2 mmHg in Group A, B and C, respectively. Myocardial protection was achieved according to the Buckberg protocol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Successful treatment of coronary artery spasm following coronary artery bypass grafting.

A case of coronary artery spasm developed 6 hours after myocardial revascularization inducing both hemodynamic and electrocardiographic changes, is reported. The spasm was documented by coronary angiography, and it was not reversed by intracoronary infusion of isosorbide dinitrate. Intravenous infusion of nifedipine (initial dose of 0.0104 mg/min to final dose of 0.0208 mg/min), along with infusion of glyceronitrate (1.0 micrograms/kg/min) was able to significantly improve hemodynamic impairment and to reverse electrocardiographic changes in 12 hours. Coronary angiography, repeated in postoperative day 3, after 48 hours of continuous nifedipine infusion, showed a resolution of coronary spasm. There was no evidence of myocardial infarction as resulted from total CPK and MB isoenzyme release. Nifedipine infusion was gradually reduced as oral administration of slow release nifedipine (40 mg twice daily) was started. The combined intravenous infusion of glyceronitrate and nifedipine seems to be able to control and overcome coronary artery spasm following coronary surgery.

Coronary Angiography↗
PubMed1993

[Myocardial revascularization in patients with compromised left ventricular function].

From March 1988 to March 1992, 69 patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD) were referred to our Institute for surgical decision making. Sixty-nine (8.2%) had LVD. In 39/69 patients we performed the identification of viable myocardium with the use of [18F] FDG/PET in fasting conditions. We divided patients with LVD into 3 groups: Group A (30 patients) operated on without preoperative [18F] FDG/PET, Group B (32 patients) with FDG uptake in akinetic segments, and Group C (7 patients) with no FDG uptake; there was no significant difference among the 3 groups in age, sex, CAD, risk factors and ejection fraction EF (Group A: 29.1 +/- 6.6%, range 16-40; Group B: 32.9 +/- 6.5%, range 20-40; Group C: 26.5 +/- 6.8%, range 18-37). All patients underwent [99mTc] MIBI/SPET to assess perfusion at rest and [99mTc] MIBI first pass radionuclide angiography to assess the EF. The study of perfusion and EF was repeated 6 months postoperatively in Group A and B. Myocardial protection was achieved according to the Buckberg protocol. Operative results in Group A and B were respectively: in-hospital deaths 2 (6.6%) versus 0 (NS), perioperative myocardial infarction 1 (3.3%) versus 1 (3.1%) (NS), IABP 10 (33.3%) versus 4 (12.5%) (p = 0.048). Postoperative EF improved both in Group A (35.1 +/- 7.1%, range 20-50; p = 0.01) and in Group B (44.2 +/- 7.7%, range 26-62; p < 0.001). In Group C 6/7 patients were scheduled for heart transplantation according to standard criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMedDate not supplied

Primary cardiac malignancy presenting as left atrial myxoma. Clinical and surgical considerations.

Primary heart neoplasms occur in 0.002-0.3% of autopsies: 30% are myxomas and 20-30% are malignancies, almost always sarcomas. Cardiac metastases are 10 to 40 times more frequent than primary heart cancer. We describe a case of a left atrial sarcoma erroneously diagnosed as myxomas preoperatively. Standard surgical indication for resection of cardiac myxomas is based on echocardiography. Because of the severity of cardiac malignant lesions than can mimic atrial myxomas at echocardiography, through preoperative investigation should be accomplished, best by magnetic resonance imaging. In case of suspected malignancy, total body computed tomography should be performed to avoid unnecessary cardiac operations in case of disseminated cancer. To date the only good medium and long-term results in the therapeutic management of heart sarcomas have been achieved by transplantation: the probable explanation is that criteria of surgical radicality should be those followed for soft tissue tumors located elsewhere in the organism.

Diagnosis, Differential↗