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Biomedical subjects

S Picardo

Publications and source records attributed to S Picardo.

At least 19 recordsLinked to original sources
PubMed1999

Pulmonary transit of sonicated albumin microbubbles during controlled mechanical ventilation: a transthoracic echocardiographic study.

UNLABELLED: Air-filled human serum albumin microspheres are ultrasonic contrast tracers that pass through the right ventricle, traverse the lungs, and effectively opacify the left heart chambers in spontaneously breathing patients. In this clinical study, we assessed whether they also do so in anesthetized patients during and after mechanical ventilation. In 20 anesthetized patients undergoing intermittent positive pressure ventilation (IPPV) for elective peripheral neurosurgical procedures, a sonicated ultrasound contrast drug (0.06 mL/kg) was injected i.v. before inducing anesthesia in spontaneously breathing patients (baseline), during IPPV, and 5 and 30 min after tracheal extubation. Transthoracic echocardiograms were obtained in the four-chamber apical view and were recorded for off-line analysis. Time to contrast appearance in the right ventricle and pulmonary transit time were measured in cardiac cycles. The peak intensity of right and left ventricular chamber opacification were scored on a scale ranging from 1 (no contrast or traces only) to 5 (attenuation). After each injection, the time for contrast appearance in the right ventricle was similar in all patients. Pulmonary transit time increased significantly during IPPV and was normal 5 min and 30 min after extubation. Right ventricular chamber opacification achieved high-grade intensity and remained constant before, during, and after IPPV. Conversely, although the baseline contrast injection resulted in high-grade left ventricular chamber opacification, the intensity decreased significantly during IPPV, remained low 5 min after extubation, and was normalized 30 min after extubation. IMPLICATIONS: During intermittent positive pressure ventilation, i.v. sonicated albumin microbubbles pass through the lungs poorly and inefficiently opacify the left ventricle compared with the effects observed during spontaneous ventilation.

Anesthesia, General↗
PubMed1998

[Unreliability of pulse oximetry in hypothermic children after cardiovascular surgery with deep hypothermic circulation].

BACKGROUND: The aim of the study was to evaluate the accuracy of oxygen saturation with the pulse oximeter (SpO2) in children undergoing cardiovascular surgery with deep hypothermic circulation. METHODS: The SpO2 values measured at the hand and at the foot were compared in 50 patients with the arterial oxygen saturation (SaO2) measured with the oximeter. A variance value between the two measurements less than 3% was considered as a reliable measurement, and the precision of the measurement was defined as the standard deviation of the variability. RESULTS: For skin temperature between 35 and 28 C grade, and for core temperature more than 34 grade, the SpO2 is a reliable measurement of the SaO2; for skin temperature less than 28 grade and core temperature less than 34 grade the SpO2 do not correspond the SaO2. CONCLUSIONS: The variability and the precision of the measurements are not affected the position of the probe (hand or foot).

Cardiovascular Surgical Procedures↗
PubMed1997

Extracardiac Fontan operation for complex cardiac anomalies: seven years' experience.

METHODS: Between 1988 and 1995, 60 patients with complex cardiac anomalies underwent a total extracardiac cavopulmonary connection, a combination of a bidirectional cavopulmonary anastomosis with an extracardiac conduit interposition between the inferior vena cava and pulmonary arteries, except in one patient in whom direct anastomosis was possible. In 40 patients the total extracardiac cavopulmonary connection followed preliminary bidirectional cavopulmonary anastomosis, associated with a modified Damus-Kaye-Stansel anastomosis in 16. The conduits were constructed of Dacron fabric (n = 34), homografts (n = 3), and polytetrafluoroethylene (n = 22). RESULTS: Total early failure rate was 15% (n = 9). Six patients died, and three more had conduit takedown owing to pulmonary artery stenosis and hypoplasia (n = 2) and severe atrioventricular valve regurgitation (n = 1). Two other patients required anastomosis revision owing to stricture. In a mean follow-up of 48 months (6 to 86 months) there were no late deaths (actuarial 5-year survival 88% +/- 4%); 52 of 54 patients are in New York Heart Association class I or II. Two patients required pulmonary artery balloon dilation or stent implantation, or both, after total extracardiac cavopulmonary connection. Late tachyarrhythmias were detected in four of 54 patients: two had sick sinus syndrome with flutter necessitating a pacemaker implantation and two had recurrent flutter (actuarial 5-year arrhythmia-free rate 92% +/- 4%). Conduit patency was evaluated by serial magnetic resonance imaging studies. Preliminary data showed a 17.8% +/- 7.6% mean reduction in conduit internal diameter during the first 6 months after total extracardiac cavopulmonary connection, with no progression over the next 5 years. CONCLUSION: These results demonstrate that the total extracardiac cavopulmonary connection provides good early and midterm results and may reduce the prevalence of late arrhythmias in patients undergoing the Fontan operation.

Actuarial Analysis↗
PubMed1996

[Diaphragm paralysis following pediatric heart surgery. Review of 25 treated cases].

Postoperative diaphragm paralysis after pediatric heart surgery is the cause of respiratory insufficiency for which there is currently no agreed treatment. The two hypotheses now considered are: early folding of the diaphragm or longterm assisted ventilation. A retrospective study from 1988 to January 1995 on the incidence of diaphragm paralysis and the type of treatment performed was carried out by the Department of Pediatric Heart Surgery of the Bambino Gesù Hospital in Rome. A total of 25 patients presented diaphragm paralysis out of 3400 operations performed and the clinical records of these patients in intensive care were reexamined. The patients were aged between 2 days and 5 years (mean 3 years) and weighed between 3 kg and 15 kg (mean 6.5). The diagnosis of diaphragm paralysis was made using fluoroscopy of the pulmonary fields during spontaneous breathing; 13 patients were extubated 7 days after diagnosis, 12 underwent surgical folding and were extubated immediately after surgery. The authors underline the particular intolerance to ventilatory insufficiency of pediatric patients after the correction of congenital cardiopathies and the need for early intervention to shorten the stay in intensive care and to avoid the onset of other severe complications such as infection. In particular, in patients undergoing Glenn's or Fontan's modified operation, the integrity of the ventilatory apparatus is essential for the correct function of the new hemodynamic status.

Cardiac Surgical Procedures↗
PubMed1995

Neonatal pulmonary autograft implantation for cardiac tumor involving aortic valve.

We diagnosed in a 4-day-old neonate a cardiac tumor involving the left atrium, left atrioventricular junction, left ventricular outflow tract, and aortic valve with severe subvalvular and valvular aortic stenosis. The critical involvement of the aortic valve and the scarcity of neonatal cardiac donors led us to perform a successful replacement of the aortic root with a pulmonary autograft, using a very small homograft for the native pulmonary valve (Ross operation).

Aortic Valve↗
PubMed1995

Multivariate prediction of in-hospital mortality associated with surgical procedures.

BACKGROUND: The aims of this prospective multicenter study were to identify variables associated with in-hospital mortality among patients undergoing surgical procedures, to develop a prediction rule, and to statistically validate its reliability. METHODS: Data from 24,654 consecutive informed patients over 15 years of age were collected from 22 surgical centers between January 1989 and December 1990. Using logistic regression analysis separate models were fit for seven surgical disciplines to predict the risk of 30-day in hospital mortality. Variables used to construct the regression models included age, sex, systolic blood pressure, renal dysfunction, hepatic dysfunction, concomitant diseases, severity of surgery, priority of surgery and duration of anesthesia. The performance of the prediction rule was evaluated by computing sensitivity, specificity and predictive values, analyzing the ROC curve and comparing observed with expected deaths. RESULTS: The significance of the independent variables varied within each model. All models significantly predicted the occurrence of in-hospital mortality. At a 0.5 cuptoint of predicted risk sensitivity of prediction rule was 99.89%, positive predictive value 98.51%, and overall predictive value 98.41%, whereas specificity was 7.92% and negative value slightly higher than 50%. The area under the ROC curve was 0.80 (perfect, 1.0). The correlation between observed and expected deaths was 0.99. CONCLUSION: This prediction rule, developed using multicenter data, is characterized by the following advantages: includes only nine variables; can be utilized by seven different surgical disciplines; is highly accurate, and is easily available to clinicals with access to a microcomputer or programmable calculator. This validated multivariate prediction rule would be useful both to calculate the risk of mortality for an individual surgical patient and to contrast observed and expected mortality rates for an institution or a particular clinician.

Adolescent↗
PubMed1995

[Post-thoracotomy analgesia in pediatric heart surgery: comparison of 2 different techniques].

The aim of this study was to compare two different post-operative pain control techniques in pediatric patients undergoing thoracotomy with reference to a control group receiving conventional treatment in the form of endovenous morphine. The post-operative antalgic treatment protocol included the random distribution of patients to three groups: control group: endovenous analgesia with morphine boluses; group 1: intrapleural analgesia with bupivacaine boluses; group 2: caudal epidural analgesia in a single bolus with a mix of bupivacaine and morphine. In the comparison it was seen that the method that offered the most effective pain control and fewest collateral effects was caudal peridural analgesia. The authors conclude by suggesting the use of this method and underlining the need to pay greater attention to the problem of postoperative pain in pediatrics.

Analgesia↗
PubMed1992

Bidirectional cavopulmonary anastomosis in patients under two years of age.

Between December 1986 and December 1990, a bidirectional cavopulmonary anastomosis was performed in 27 patients younger than 2 years of age, including 12 with heterotaxia syndrome. Age and weight of patients averaged 14.2 +/- 6.6 months and 8.1 +/- 2.2 kg, respectively. Eleven had pulmonary atresia and 16 had pulmonary stenosis. The main pulmonary artery was ligated in seven patients in the latter group (subsequently reopened in one) and left open in nine (subsequently ligated in two). There were four hospital deaths (15%). All patients were discharged with anticoagulant/antithrombotic therapy to be continued for 6 months. There were two late deaths before further operations (8.7%). Two patients, one with acquired massive pulmonary arteriovenous fistulas and one with progressive common atrioventricular valve regurgitation, subsequently underwent definitive repair (biventricular in one), and both died. Heterotaxia syndrome (p = 0.087) and preoperative mean pulmonary artery pressure higher than 15 mm Hg (p = 0.09) were the only risk factors for overall mortality.

Anastomosis, Surgical↗
PubMed1992

Total extracardiac right heart bypass.

BACKGROUND: Total cavopulmonary connection has been proposed as a rational alternative to atriopulmonary connection for complex Fontan operations. In addition to fluid dynamic advantages proposed by de Leval, total right heart bypass may address an emerging important issue after repair of single ventricle: late atrial arrhythmias. The purpose of this study is to document the postoperative hemodynamic findings in 22 consecutive patients who received a total extracardiac right heart bypass with an inferior vena cava-to-pulmonary artery extracardiac Dacron conduit with a modified Glenn anastomosis (superior vena cava-to-pulmonary artery anastomosis). METHODS AND RESULTS: Twenty-eight patients with complex congenital heart disease underwent this surgical procedure. One patient died (early mortality, 3.5%). Mean follow-up was 13.9 months. Postoperative cardiac catheterization and echo Doppler studies were performed in 22 of the 27 survivors. In 18 of 22 patients, hemodynamic data were satisfactory; a preferential direction of caval flows to both lungs was observed. Echo Doppler assessments show that forward cavopulmonary flow appears as a predominant early diastolic event, in contrast to what occurs in atriopulmonary connections. This hemodynamic model emphasizes the possible role of the diastolic ventricular performance (as a "suction pump") in Fontan circulation. Early postoperative atrial arrhythmias were observed in two of the survivors. CONCLUSIONS: The technical advantages and the hemodynamic benefits of this form of right heart bypass are encouraging. Although the use of artificial material in this procedure is extensive, none of the survivors showed thromboembolic complications or peel formations with narrowing and/or obstruction. Further investigations during a longer follow-up are needed to confirm the early and intermediate results, especially the reduction of late atrial arrhythmias.

Anastomosis, Surgical↗
PubMed1989

Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation.

A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has been the accepted mode of treatment for patients with complex cyanotic congenital heart disease. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were considered less than "ideal" candidates for a Fontan procedure. We divided the patients into two groups: group 1 had azygos continuation and group 2 did not. Fourteen patients required hypothermic cardiopulmonary bypass. Bidirectional pulmonary blood flow was achieved in all patients. Only 1 death occurred (group 2). The improvement in oxygen saturation and overall clinical condition of these patients, together with the low mortality and morbidity, is encouraging. However, long-term follow-up is mandatory for a comprehensive evaluation of this surgical approach as definitive palliation or as a first stage for a Fontan operation.

Arteriovenous Shunt, Surgical↗
PubMed1989

Discrete subaortic stenosis. Surgery in children based on two-dimensional and Doppler echocardiography.

Twenty pediatric patients underwent surgical resection of a "discrete" subaortic membrane. The diagnosis and the surgical indication were based on two-dimensional and Doppler echocardiography without cardiac catheterization and angiography. In all patients the echocardiographic diagnosis was confirmed at surgery in terms of presence, dimension and location of the membrane and in ten patients in terms of pressure gradients. Two-dimensional and Doppler echocardiography has proved to be a very reliable tool for the diagnosis and surgical indication in pediatric patients with a DSAS. Our criteria for the selection of surgical patients are the following: (1) isolated form of discrete subaortic stenosis with a short base of attachment to the ventricular septum; (2) pressure gradients higher than 25 mm Hg; (3) presence of significant aortic insufficiency. All of this information can be consistently obtained with two-dimensional and Doppler echocardiography.

Aortic Valve Stenosis↗
PubMed1989

[Seroma: a complication of systemic-pulmonary shunt with a tubular prosthesis].

The accumulation of clear fluid leaking from a tubular prosthesis and confined within a fibrous pseudomembrane has been defined as a "seroma". Both the literature and our experience on this complication have been reviewed. Fifty-three cases of seroma have been reported after implantation of a tubular prosthesis. In our experience, from June 1982 to September 1988 we observed 11 cases (11/108 = 10.1%) of seroma complicating a modified Blalock-Taussig procedure. The mean age of these patients was 2 years 2 months. The diameter of the implanted tubular prostheses was always 5 mm. Among these cases, we report the details of a child, 1 year 10 months old, in whom the seroma significantly complicated the surgical history. According to the data derived from the literature and from our experience, we derived the following risk factors for the occurrence of seroma: age of the patient, size of the prosthesis, surgical manipulations, arterial-venous gradient, transprosthetic flow.

Anastomosis, Surgical↗
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↗