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Biomedical subjects

U Livi

Publications and source records attributed to U Livi.

At least 91 records · Page 5Linked to original sources
PubMed1988

Repair of congenitally malformed mitral valve in children.

We report our experience with 30 children under 15 years of age treated surgically for congenital mitral valve disease from March 1972 to July 1986. Valve reconstruction was possible in 26 patients (87%), whereas in four the valve was replaced with a mechanical prosthesis. Five patients died in the hospital (16.6%), four after conservative operations and one after mitral valve replacement. There was only one late death in a child in chronic congestive heart failure. Three patients, treated conservatively, required valve replacement 2, 22, and 24 months, respectively, after the operation. Follow-up data reveal that 22 of 24 patients are asymptomatic 5 months to 15 years after operation. Two-dimensional echocardiographic studies were performed in 19 patients treated conservatively, 17 of whom are asymptomatic. Eleven of them have no signs of mitral regurgitation or stenosis, six show only mild mitral incompetence, and two have moderate mitral regurgitation or stenosis. Peak pulmonary artery pressure is within normal limits in all. Our results indicate that mitral valve reconstructive procedures for congenital valve dysplasia may be effective and reliable in children despite the frequent severity of valve malformation. Although no major prosthesis-related complications were observed in the present series, we believe that mitral valve repair should always be attempted in the pediatric population to avoid the drawbacks of the currently available prostheses.

Adolescent↗
PubMed1988

Tricuspid atresia versus other complex lesions. Comparison of results with a modified Fontan procedure.

Several modifications of the Fontan principle are currently applied to the treatment of tricuspid atresia with low mortality. The use of these modifications in other malformations has most frequently been associated with less satisfactory results. At our institution, from June 1977 to October 1986, 35 consecutive patients, whose ages ranged from 8 months to 20 years (median age 3.4 years), underwent a modified Fontan procedure. Twenty patients with a median age of 3.2 years (group I) having tricuspid atresia (16 patients) or hypoplastic right heart syndrome (four patients) were treated by means of a right atrium-pulmonary artery anastomosis (12 patients) or right atrium-subpulmonary chamber connection (eight patients). Fifteen patients (group II) with a median age of 3.6 years, having a single left ventricle (10 patients), left atrioventricular valve hypoplasia or atresia (three patients), or double-outlet right ventricle (two patients), underwent right atrium-pulmonary artery anastomosis, together with a repositioning of the atrial septum to the right of the right atrioventricular valve, which thus left intact the inlet to the ventricle(s). The operative mortality rate was 25% in group I and 0% in group II. One patient in group I and one in group II died late postoperatively. All the 28 survivors are free of symptoms 3 months to 9 years after correction. According to our results, low risk can be associated with modified Fontan procedures in the treatment of complex heart malformations other than tricuspid or pulmonary atresia. Preserving the integrity of the entire inlet to the ventricle(s) by repositioning the interatrial septum, as done in group II malformations, might be helpful in improving the quality of the repair.

Adolescent↗
PubMed1988

[Incidence of aortic recoarctation in 161 patients after a mean follow-up of 8 years. The usefulness of pressure gradient measurement at rest and following exercise and of digital angiography].

The incidence of aortic recoarctation has been evaluated after a mean follow-up period of 8.2 years in 161 patients aged from 2 to 54 years at the time of the operation. To this aim, blood pressure levels in the upper and lower limbs were measured at rest and after bicycle ergometer exercise. Patients whose systolic pressure gradient was significant (either above 20 mmHg at rest or 35 mmHg after exercise) underwent aortic digital angiography. Aortic coarctation was diagnosed when the ratio of the aortic area at the site of the operation was less than 40% of that at diaphragmatic level (Frederiksen's index III). Thus the overall incidence of recoarctation was 10.1%. All patients with a significant gradient at rest also showed a significant gradient after exercise. This suggests that it is worthwhile performing digital angiography directly, without exercise testing, in these patients. However, 39.8% of the patients without significant rest gradients displayed a significant gradient after exercise. On the whole, only 21.4% of the patients with a significant gradient after exercise had signs of recoarctation on digital angiography.

Adolescent↗
PubMed1987

Viability and morphology of aortic and pulmonary homografts. A comparative study.

In view of possible clinical use of the pulmonary homograft for right ventricular outflow tract reconstruction a comparative study with the aortic counterpart was performed. Samples of aortic and pulmonary walls from 10 cadaveric hearts were assessed for viability and morphologic characteristics before and after storage in nutrient-antibiotic solution. The viability, as evaluated by an autoradiographic technique, was similar in both aortic and pulmonary specimens at the time of dissection, after 2 weeks, and after 4 weeks of storage. The histologic examination showed no changes in the structure of the media in all samples up to 4 weeks of storage. The total calcium content per gram of tissue in the pulmonary media was on an average less than half of that in the aortic counterpart. We conclude that the pulmonary homograft is preserved the same as the aortic homograft and, accordingly, it becomes available for clinical application. Moreover, a lesser content of elastic tissue and a lower amount of total calcium may, in all likelihood, make the pulmonary wall less prone to calcification.

Adolescent↗
PubMed1986

Distal internal mammary artery (IMA) with retrograde flow for coronary artery grafting.

A case in which the right distal internal mammary artery (IMA) was used to graft the posterior descending branch of the right coronary artery is presented. The retrograde blood flow at dissection was 60 ml per minute, no electrocardiographic signs of myocardial ischemia were detected postoperatively. The patient is well and fully active 6 months after surgery.

Coronary Vessels↗
PubMed1985

The risk of surgical treatment of tetralogy of Fallot: an appraisal.

The risk of surgical treatment of tetralogy of Fallot was analyzed with multivariate statistical techniques in a recent surgical series (1975-1983) of 159 corrected and 59 palliated patients. The overall mortality of correction was 12.6% and that of palliation was 15.3%. The significant and independent risk factors that increased the mortality of palliation were the use of a shunt other than the Blalock or its modifications (mostly Waterston) (P = 0.01), and very young age (P = 0.02). Risk factors that increased the mortality of correction were high left over right ventricular pressure ratio (P-RV/LV) (P = 0.02), persistent patency of the arterial duct (P = 0.02), other major associated lesions (P = 0.02), and the use of a transannular patch (P = 0.04). Cardioplegia significantly decreased the risk (P = 0.03). With present techniques, correction can be performed in favorable cases with a mortality approaching zero. Staged procedures neutralized the age related risk of correction, but Blalock shunts carried a mortality rate ranging from 9.5% at 1 month to 1.7% at 12 months of age. This was due to the lack of prostaglandins along with technical faults. Predicted two-stage mortality rates ranged in infants (less than 12 months) from 6.2 to 16% and compared favorably with our observed 27% mortality of primary correction. Our results show that the transannular patch becomes a fully expressed risk only in those patients with restrictive pulmonary arteries or isolated branch stenosis. This is because it decreases the force the right ventricle can generate in maintaining the cardiac output. The chances of survival, when compared with those of patients without transannular patch, are significantly less when the P-RV/LV is between 0.6 and 1.0. We therefore discuss the measures to decrease or neutralize this risk related to insertion of a transannular patch. Among the associated lesions, we discuss briefly the potential for residual right outflow tract stenosis, anomalous origin of the left anterior descending coronary artery and anomalous muscle bundle of the right ventricle.

Adolescent↗
PubMed1985

Surgical management of double-outlet right ventricle.

From 1977 to 1983, 32 consecutive patients, ranging in age from 15 days to 24 years, underwent operations for double-outlet right ventricle. Twenty patients had a palliative operation either to increase (12 cases) or to reduce (eight cases) pulmonary blood flow: Ten of them have subsequently undergone total repair, and in another six correction was delayed because of possible incremental operative risk factors, such as multiple ventricular septal defects or the need for an extracardiac conduit. Four patients with multiple, complex associated intracardiac anomalies are currently considered to have uncorrectable defects. A total of 22 patients underwent correction either primarily (12) or after palliation (10). Intraventricular tunneling was performed in 16 patients with a subaortic ventricular septal defect and in one with a doubly committed ventricular septal defect. Seven of these had pulmonary stenosis and five had reconstruction of the right ventricular outflow by means of a patch (three) or a conduit (two); among this group, five also had enlargement of the ventricular septal defect. In three patients with a subpulmonary defect and in one with a remote ventricular septal defect, all of them without pulmonary stenosis, total repair was achieved by a Senning, a Mustard, or an arterial switch operation. Finally, the only patient with atrioventricular discordance and pulmonary stenosis had insertion of a left ventricle-pulmonary artery conduit. No operative deaths were observed after palliation, but one patient died of intrapulmonary hemorrhage after total repair (4.5%). Major postoperative complications included detachment of the ventricular septal defect patch in one patient and late progression of pulmonary vascular obstructive disease in another. No late deaths have been recorded. Surgical repair of double-outlet right ventricle can be accomplished with gratifying early and late results, the risk of operative death being below 5%. The outcome in patients with subaortic ventricular septal defect appears particularly favorable, despite the extensive intracardiac procedures required for total correction. An early intervention is recommended to prevent development of pulmonary vascular obstructive disease and to avoid massive cardiac hypertrophy and fibrosis, which may cause late rhythm disturbances and impede the intracardiac repair.

Adolescent↗
PubMed1984

Cardiac myxomas: results of 14 years' experience.

From January 1968 to July 1983, 38 patients with an intracardiac myxoma underwent surgical excision of the tumor at our Institution. There were 15 males and 23 females, ranging in age from 17 to 68 years (mean 47.7). In all but 2 patients, the presence of an intracardiac myxoma was documented preoperatively by angiographic and/or echocardiographic study. The first 2 patients of this series were referred with the diagnosis of mitral stenosis, and the myxoma was an unexpected surgical finding. In 32 cases (84.2%) the myxoma was located in the left atrium, in 4 (10.5%) in the right atrium and in 2 (5.3%) in the right ventricle. Surgery was performed on an emergency basis in 36 patients. Two patients (5.2%) both with a left atrial myxoma, died after surgery: one died intraoperatively of hemorrhage and the other after one month of bowel infarction. Follow-up of the 36 survivors ranges from 3 months to 14.5 years (average 5.2 yr); all were controlled by means of clinical and echocardiographic investigations, and no evidence of tumor recurrence was detected. Surgery for intracardiac myxoma, which should be undertaken on an emergency basis, carries a low operative risk; excision of the tumor appears to be curative with no recurrences at long-term follow-up; non-invasive tools are of the utmost importance in both the preoperative assessment and follow-up of these patients.

Adolescent↗
PubMed1984

The use of an autogenous vaccine in the treatment of sternal wound infections following open heart procedures: a preliminary report.

Five patients, who developed sternal wound infection following open heart surgery and in whom the standard methods of management of this complication had been unsuccessful, were treated with an autogenous vaccine. Complete healing of the sternal wound was obtained in 4 of them, while in one, who had an associated mediastinitis, a slow recovery with persistence of a sternal fistula occurred. The results of this preliminary experience indicate that the use of an autogenous vaccine might be regarded as an alternative method of treatment of sternal infections in selected patients.

Adult↗
PubMed1983

Mitral valve prosthesis dehiscence necessitating reoperation. An analysis of the risk factors involved.

Between January 1970 and December 1981, a total of 21 reoperations for periprosthetic leak were performed on 20 patients out of 999 with previously implanted prosthetic mitral valves. In most of them reoperations were performed within the first year, since the initial procedure and the leading indications were intractable congestive heart failure or infection of the mitral prosthesis. The mortality rate was 30% and was related to the preoperative cardiac functional status. The preoperative variables significantly related to an increased incidence of dehiscence of the mitral prosthesis necessitating reoperation were a degenerative disease (P = 0.016) or an infective endocarditis (P = 0.0006) of the native valve, both causing mitral regurgitation. Rheumatic disease, type of prosthesis, supra- or subannular insertion, age of the patient, and operative year, were not significant, neither were calcifications that are probably neutralized by the routine use of special surgical techniques. It is suggested that the use of techniques specifically designed to eliminate periprosthetic leak in patients affected by mitral regurgitation due to degenerative or infective disease of the native valve, might lead to a further reduction of reoperations for this complication.

Adolescent↗
PubMed1982

Surgical treatment of patients with triple heart valve disease. Results and analysis of factors affecting the surgical outcome.

During a 10-year period (1972 to 1981), 48 patients underwent repair of combined aortic, mitral and tricuspid disease at our Institution. The aortic valve was replaced in 47 cases and treated by valvulotomy in one; the mitral valve was replaced in 47, and conservatively managed in one by means of open mitral commissurotomy; the tricuspid valve was treated by annuloplasty in 37, by commissurotomy in 3 and replaced in 8. Operative mortality decreased from 67% among those cases operated on normothermic cardiopulmonary bypass (CPB) with coronary artery perfusion (1972 to 1973) to 23% in those operated with mild hypothermic CPB and intermittent aortic cross-clamping (1974 to 1976), to 8% in patients treated with mild to deep hypothermic CPB and cold cardioplegic solutions (1977 to 1981) (p = 0.012). Analysis of the factors affecting the surgical risk has demonstrated that age at the time of operation, preoperative functional class, duration of the disease, preoperative cardiothoracic ratio and insertion of a prosthesis in the tricuspid position did not significantly influence the operative result. On the contrary, the recent techniques of myocardial protection with the use of cold cardioplegia, possibly associated with an earlier indication for operation and a prompter treatment of postoperative complications, were the major determinants of the improved surgical outcome.

Adult↗