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V Baldrighi

Publications and source records attributed to V Baldrighi.

At least 19 recordsLinked to original sources

Associated coronary and cardiac anomalies in the tetralogy of Fallot. An angiographic study.

Numerous studies have pointed out the frequent association of tetralogy of Fallot (TF) with other cardiovascular defects and coronary tree anomalies. We found cardiac defects in 181 (68%) out of 265 patients with TF investigated by catheterization and selective coronary angiography. These anomalies were isolated in 88 cases (49%) and associated with others in 93 patients. In the case of an isolated anomaly associated with TF, the coronary tree was involved in 37.5% and the cardiovascular system in the remaining 62.5%; in the case of two anomalies, the coronary system was involved in 66% of the patients and the cardiovascular apparatus in 34%; in the case of three or more anomalies, the coronary arteries were involved in 71% and the cardiovascular system in 29%. Anomalies in the course and/or distribution of coronary arteries were present in 96 patients (36%): 10 had a single coronary ostium, 13 a left anterior descending artery arising from the right coronary artery, one a circumflex artery arising from the right coronary artery. Small fistulas between coronary arteries and the pulmonary artery were found in 20 cases; anastomoses between coronary and bronchial arteries or right atrium in 42. In 39 patients we observed a large conus artery or large anterior ventricular branches crossing the right ventricle. A right aortic arch was found in 56 patients (21%), a stenosis of the trunk and/or the peripheral pulmonary artery in 35 (13%) and pulmonary artery atresia in five. Four patients showed a complete atrioventricular canal, three an atrial septal defect (primum type) with cleft of the mitral valve, 61 (23%) an atrial septal defect (ostium secundum). Eleven patients had anomalies of the systemic venous return, 26 (10%) a patent ductus arteriosus. Four patients had valvular abnormalities. In our series, a large proportion of cardiac defects associated with TF consists of anomalies of coronary arteries. Our data confirm the usefulness of performing preoperatively routine coronary angiography in patients with complex congenital heart disease.

Abnormalities, Multiple↗

Coronary artery anatomy in corrected transposition of the great arteries.

Congenitally corrected transposition of the great arteries is an unusual cardiac malformation with discordant atrioventricular and ventriculoarterial alignments. Because knowledge of the coronary artery anatomy is a prerequisite for successful repair of this cardiac anomaly, selective coronary arteriography was performed in 13 children (4 male and 9 female; age range 18 months to 16 years) and 1 adult (aged 59 years) with congenitally corrected transposition of the great arteries and associated intracardiac defects. The typical coronary distribution of corrected transposition (that is, coronary artery-ventricular concordance) was found in 11 patients. In one patient, a single coronary ostium was observed; the right sinus of Valsalva gave rise to a short common branch that divided into three arteries: a left circumflex artery going to the right, a well developed left anterior descending artery running into the anterior interventricular groove and a third vessel that continued on the normal course of the right coronary artery directed posteriorly. In one patient, the left circumflex artery was particularly small. In another patient, with severe hypoplasia of the left anterior descending coronary artery, the anterior ventricular wall of the heart was supplied by three small branches that ended a short distance from their origins. The adult patient had a large anterior ventricular branch arising from the morphologic left coronary ventricular as well as a large acute marginal branch, with a wide distribution, from the morphologic right coronary artery. Presurgical coronary angiographic documentation is helpful because, in congenitally corrected transposition as well as in complex congenital heart disease, coronary anomalies (in origin, course and distribution) are occasionally present and knowledge of their presence can help determine the most appropriate surgical approach.

Child↗

Double-blind clinical evaluation of dimetophrine in chronically reduced arterial tension.

Thirty in-patients with chronically reduced arterial blood pressure and relevant subjective symptoms were treated over a 15-day period with oral doses of either 400 mg dimetophrine twice daily or placebo, according to a prospective, randomized, double-blind design. Systolic and diastolic blood pressures and heart rate were monitored at 5-day interval: subjective specific symptoms (scored 0 to 3 in order of increasing severity), haematology and haematochemistry were recorded before and after treatment. Both systolic and diastolic blood pressures increased significantly after dimetophrine all through the observation period. After 5 days, systolic blood pressure had already reached significantly higher values in comparison with the placebo-treated group, as did diastolic blood pressure by the 10th day. Overall, during the observation period, an increase from 82.7 +/- 1.0 to 112.3 +/- 2.1 mmHg was observed in systolic and from 54.3 +/- 1.3 to 62.7 +/- 1.4 mmHg in diastolic blood pressure with dimetophrine, whereas with placebo, systolic blood pressure increased from 80.4 +/- 1.5 to 93.7 +/- 2.9 mmHg and diastolic blood pressure remained unchanged (53.3 +/- 1.4 mmHg). Concomitantly, heart rate decreased significantly with dimetophrine from 88.1 +/- 2.5 to 77.2 +/- 1.4 beats/min, whereas it remained almost unchanged with placebo (from 83.9 +/- 2.5 to 80.0 +/- 1.9 beats/min). The associated symptoms (asthenia, paleness, drowsiness, fatigue, sweating, vertigo and headache) were largely relieved by dimetophrine (70.0% decrease) but not by placebo (37.4%). All symptoms except drowsiness and vertigo were reduced to a significantly larger extent with dimetophrine than with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Surgical therapy of the dissection of the ascending aorta. Experience in the use of the G. R. F. biological glue].

Nine patients with dissecting aneurysm of the ascending aorta (type A dissection) were operated upon. Six cases had an acute dissection, whereas three cases had a chronic type of dissection. The ascending aorta was replaced with a Dacron tubular prosthesis after solidification of the external and the internal layers of the two aortic stumps using a G.R.F. biological glue. Early and late results as well as the possible complications during the post-operative course are reported. Furthermore the advantages in using the G.R.F. glue are discussed in details. They are mainly represented by the excellent solidification of the aortic stumps, by the possibility to correct the aortic regurgitation without valve replacement and particularly by a good hemostasis of the surgical sutures.

Adult↗

[Cineangiographic and hemodynamic evaluation of left bundle branch block].

Left cardiac catheterisation, selective coronarography and ventriculography were employed in a study of 89 patients with left bundle-branch block. Three subjects presented normal haemodynamic and cineangiographic data, 16 displayed valve defects, usually of the aorta, 34 had ischaemic heart disease, and 36 cardiomyopathy mostly of a congestive type. Deviation of the axis in excess of--30 degrees on the frontal plane appeared to be more frequently accompanied by ischaemia, though this finding was not prognostic from the haemodynamic standpoint. A prolonged QRS (over 0.15") was more frequent in valvular heart disease and accompanied by more evident left valve dysfunction. Comparison between the 34 ischaemic patients and 317 coronary patients without left bundle-branch block showed that the former has a higher frequency of leftness in the distribution of their coronary circulation, and more extensive impairment of the coronary arteries, especially the ramus interventricularis anterior. Changes in left ventricle kinetics and serious hypokinesia and/or akinesia appear to be due to the heart disease responsible of the block. The series examined did not make it clear whether this intraventricular conduction defect can cause albeit slight alterations in left ventricle wall motility.

Adult↗

Distribution and anomalies of coronary arteries in tetralogy of fallot.

The surgical management of tetralogy of Fallot (TF) may be complicated by anomalies in the course and distribution of coronary arteries. Selective coronary angiography was performed in 119 cases of TF in order to prevent injury of aberrant vessels. In 11 patients, anomalies in the origin of coronary branches were revealed (five patients with a single coronary ostium, five with the anterior descending coronary artery arising from the right coronary artery or right sinus of Valsalva, and one with the circumflex artery arising from the right coronary artery). Other findings include anastomoses between coronary and bronchial arteries, small fistulas between coronary arteries and the pulmonary artery or right atrium, and hypoplasia of the coronary tree. The onset of left anterior hemiblock after total correction of TF could possibly be explained, in cases with a dominant left pattern, by injury to the coronary system after closure of the interventricular septal defect, rather than by injury to the conduction system.

Adolescent↗

[Distribution and anomalies of coronary arteries in tetralogy of Fallot (author's transl)].

Anomalies in the course and distribution of coronary arteries may complicate the surgical correction of tetralogy of Fallot (TF). With the aim of preventing possible serious, and even lethal, cardiac events caused by the injury of aberrant vessels, 119 patients with TF were subjected to selective coronary angiography. Apart from demonstrating anastomoses between the coronary and bronchial arteries in 31 cases, small fistulas between the coronary arteries and pulmonary artery (in 14 cases) and hypoplasia of the entire coronary tree in 1 case, this investigation revealed anomalies in the origin of coronary branches in 11 cases. In some cases the first septal branch was absent and the diagonal branches were poorly developed. An injury to the coronary system, following the closure of the interventricular septal defect, may possibly explain the onset of a "left anterior hemiblock" after total correction of TF. Selective coronary angiography in small children presents no riskes provided it is correctly performed. In our cases no complications arose.

Adolescent↗

[Coronary cardiopathy].

Results obtained with selective coronariography, ventriculography, left catheterisation and the measurement of systolic times were compared in a series of 110 patients. Evaluation of vascular alterations with the aid of a coronary index showed that their entity was closely related to the incidence of asynergia and the extent to which left ventricular function was compromised. Index values were proportional to decrease of the DP/DT ratio, increased telediastolic pressure, lengthening of the pre-ejection phases and shortening of left ventricular systole. The physiopathological and clinical significance of these results is discussed.

Adult↗