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Biomedical subjects

V Di Luzio

Publications and source records attributed to V Di Luzio.

At least 19 recordsLinked to original sources
PubMed2000

Usefulness of transesophageal echocardiography in the assessment of aortic dissection.

The acute dissection of the ascending aorta requires prompt and reliable diagnosis to reduce the high risk of mortality; in addition, prognosis is influenced by long-term complications. The aim of this article is to discuss transesophageal echocardiography (TEE) and (1) its diagnostic accuracy in the presurgical evaluation of patients, (2) its role in reducing time of diagnosis and surgery, and (3) its ability to reduce hospital mortality. TEE has also been tested as a screening method in the postsurgical follow-up of these patients. The retrospective investigation concerns a sample of 80 cases of acute dissection of the aorta, submitted for surgical intervention from April 1986 to February 1999. TEE has allowed a precise estimation of aortic diameters and optimal visualization of intimal flap and tear entry with a fine distinction between true and false lumen. A direct comparison of the results of TEE and of transthoracic echocardiography has demonstrated that some elements (visualization of flap and diameters in descending aorta, sites of entry and reentry, direction of jet trough intimal tears, phasic intimal flap movement, diastolic collapse of flap on the valvular plane, false lumen thrombosis, coronary involvement, intramural hematoma, and aortic fissuration) were identified only by TEE, whereas other additional diagnostic elements (cardiac tamponade, aortic valve insufficiency, left ventricular function) show a similar pattern of significance. Routine employment of this method has confirmed a reduction of hospitalization time (about 1.5 hours of waiting time), and hospital mortality has changed from 42.8% to 17.3%. In the follow-up of patients operated on for aortic dissection, fundamental information may be obtained from TEE (assessment of the progression of thrombosis in the false lumen with its complete obliteration and modifications in aortic diameter with a consequent, possible worsening of aortic valve insufficiency). In conclusion, our study demonstrated that TEE may provide fast and efficient detection of acute aortic dissection. In the postsurgical follow-up, TEE has confirmed detection of major complications that can influence long-term prognosis and may be proposed as a method with easy access-one that is repeatable and inexpensive for the screening of aortic dissection surgical patients.

Aortic Dissection↗
PubMed1998

Optimal ("stent-like") acute angiographic results pursuable by traditional PTCA.

OBJECTIVES: This study was undertaken: 1) to assess the efficacy of traditional PTCA in affording "optimal" initial dilatation (OID) of coronary stenoses (as assessed by on-line quantitative angiography) defined as a post-procedure residual lumen narrowing < or = 20%; 2) to determine clinical and angiographic correlates of these types of successes. BACKGROUND: Recent reports have shown that acute angiographic results achieved by traditional PTCA, resembling those obtainable by elective stenting, carry low risks of restenosis. However, safety and the ability of conventional PTCA to consistently provide acute stent-like results are still practically unknown. PATIENTS AND METHODS: Using a "standardized" procedural protocol intended to optimize acute angiographic results, 878 consecutive non-selected patients, 750 men and 128 women aged 29-78 years (mean 60.5 yrs) underwent PTCA on 1054 lesions. Compliant balloons reaching nominal dimensions at 6 atm and predicted balloon-artery ratios of 0.92-1.05 (mean 1.02) were used. An inflation pressure of 5 atm was gradually and slowly applied initially (usually sufficient to reach the point of plaque fracture). Inflation times of 60 seconds and step-increases in inflation pressure of 1 atm were subsequently utilized, until a large lumen with smooth contours (the nearest to normal) or any wall damage were detected by angiographic tests performed at each step. Inflations were stopped when, even in the presence of sub-optimal dilatation, the inflation pressure of 14 atm was reached (which usually corresponded to an effective balloon/artery ratio < 1.15). RESULTS: Overall traditional primary successes were 830 (94.5%) for patients and 1001 (95%) for lesions. Major complications, without mortality, were 24 (2.7%). CABS was necessary in 17 patients (1.9%) while acute myocardial infarction occurred in 7 patients (0.8%). OID was obtained in 65.4% of the treated lesions: 77.9% in type A, 73.9% in B1, 54.0% in B2 and 32.5% in C lesion subgroups of the AHA/ACC classification scheme. Multivariate analysis showed that no clinical variables significantly influenced OID. Lesion-related variables such as chronic occlusion, diffuse disease, length > 10 mm, heavily calcified and markedly angulated lesions emerged as (negative) determinants of success. CONCLUSIONS: Acute stent-like angiographic results are obtainable by conventional PTCA in a consistent percentage of eligible coronary lesions. Following a safe modality of balloon-stress application in performing angioplasty, probability of safely achieving OID of coronary stenoses is related to specific angiographic lesion characteristics.

Adult↗
PubMed1997

Coronary restenosis after optimal (stent-like) initial angiographic results obtained by traditional balloon angioplasty.

BACKGROUND AND OBJECTIVE: Elective native coronary artery stenting has shown its efficacy in lowering restenosis rates (RR) usually occurring after balloon angioplasty (PTCA). However ability of conventional PTCA to consistently provide low RR, through the achievement of large acute stent-like angiographic results, has not been investigated. This study was conducted to: (1) assess ability of optimal initial dilatation (OID), defined by residual lumen narrowing < or = 20%, significantly reduce current high RR following traditional PTCA; (2) evaluate the efficacy of OID obtainable by conventional PTCA in influencing adverse effects of single variables predisposing to restenosis. METHODS: Of consecutive 601 patients who underwent PTCA, 569 (94.6%), 483 men and 86 women, aged 38-76 years, had a successful procedure on 645/678 lesions (95.1%). After a plaque fracture was obtained by the first inflation, step-increases in pressure of 1 atm and 60 second-inflation-times were applied, until a large lumen (the nearest to normal) and smooth contours were seen, or any wall damage detected by using step-by-step angiographic tests. Acute optimal results (group A) were 450 (69.7%) and sub-optimal results (group B) were 203 (30.3%). After a mean time of 9 +/- 1.8 months, 543 patients (95.4%) had angiographic restudy on 611 (94.7%) successfully treated lesions. RESULTS: Restenosis (> 50% stenosis at restudy) occurred in 27.1% of patients and in 24.5% of lesions. RR was 18.8% in group A and 37.8% in group B (p < 0.0001). Significant lower RR were observed in group A in comparison with group B, for single variables examined, except for length > 10 mm. By multivariate analysis of all treated lesions, sub-optimal initial dilatation, unstable angina, lesion length > 10 mm and eccentricity emerged as major determinants of restenosis. Following OID only length > 10 mm was highly predictive of this event and, in the absence of this adverse variable, RR was only 13.6%. CONCLUSION: Counterbalancing adverse effects of many variables predisposing to restenosis, OID obtained by traditional PTCA seem to significantly reduce the risk of recurrence, particularly in lesions no longer than 10 mm.

Adult↗
PubMed1988

Giant left atrium and mitral valve replacement: risk factor analysis.

Giant left atrium (GLA) associated with mitral valve disease (MVD) has been reported as a significant risk factor in mitral valve surgery with mortality ranging from 8%-32%. Plication of the left atrium has been suggested to reduce postoperative left ventricular failure, respiratory failure and mortality. The 203 consecutive patients with MVD operated upon between 1980 and 1986 were reviewed and divided in two groups: group A without GLA (165 patients) and group B with GLA (38 patients = 19%). The pertinent preoperative and intraoperative notes and the early and late postoperative course were reviewed and correlated. The hospital mortality was 2.4% in group A and 2.6% in group B. Late mortality, at a mean follow-up of 54 months was 4.3% in group A and 5.4% in group B. In this series, GLA was not a significant risk factor in MVR and did not affect early and late results as compared with cases without GLA. Plication may not be required in absence of extracardiac signs of compression.

Cardiomegaly↗
PubMed1979

[Congestive heart failure in genetic hypertrophic cardiomyopathies (ASH) (author's transl)].

Of a total sixtytwo patients covering all the spectrum of genetic ASH, who were studied by heart catheterization, M-mode echocardiography and phonomechano cardiography, five patients (four with the obstructive variety of the disease) showed clinical evidence of chronic congestive heart failure with ankle edema and hepatomegaly (group I). Their data were compared with those of fifteen "obstructed" patients who were not in heart decompensation (group II). No statistically significant differences were found between groups I and II in terms of L.V. internal transverse dimensions and in terms of L.V. systolic function. Conversely a statistically significant difference was found between the two groups in terms of left atrial and right ventricular dimensions (P less than 0,001), which were markedly increased in groups I. These findings strongly suggest that in patients with ASH and congestive heart failure there is a reduction in L.V. compliance (or distensibility), whereas L.V. systolic function is essentially preserved. The persistence of severe L.V. outflow obstruction in four patients of I group gives further confirmation to these observations. The use of beta-blockers (in association or not with cardiac glycosides) seems therefore to preserve its validity in the treatment of patients with ASH and heart failure, particulary when severe L.V. outflow obstruction is present. Cardiac glycosides are indicated in the forms with little or no obstruction to L.V. ejection.

Adult↗
PubMed1979

[The tricuspid valve prolapse. Clinical significance and diagnostic problems (author's transl)].

Systolic prolapse of the tricuspid valve is a relatively unknown anatomo-clinical entity. In this communication etiology, clinical significance and diagnostic problems of this condition are reported and discussed. The frequent association with mitral valve prolapse and the coexistence of skeletal and cardiac anomalies strongly suggest the role of congenital factors and the degenerative nature of this valvular abnormality. Pathophysiology of leaflets prolapse remains unexplained for those few reported cases of isolated tricuspid invovlement. The clinical diagnosis of tricuspid valve prolapse is difficult, since the characteristic physical signs of tricuspid incompetence are uncommon, while apical mid-systolic click-late systolic murmur may indicate mitral valve prolapse, tricuspid valve prolapse, or a combination of the two. In the reported cases selective right ventriculography (R.A.O.) has shown pansystolic or late systolic prolapse of anterior and inferior leaflets (without or with varying degree of tricuspid incompetence) or isolated late systolic prolapse of the inferior cusp. M-mode echocardiography has shown great value in the diagnosis of tricuspid valve prolapse. On the echocardiogram several types of abnormalities have been noted which correlated well to angiocardiographic data. Tricuspid valve prolapse is of clinical importance, since this condition may be associated with significant tricuspid incompetence, a high incidence of cardiac arrhythmias, and possibly with bacterial endocarditis.

Adolescent↗
PubMed1979

[Echocardiographic patterns of congenital aneurysm of the sinus of Valsalva. Review of literature and report of three cases (author's transl)].

The (M-mode) echocardiographic patterns of three patients with congenital aneurysm of the right sinus of Valsalva are reported. In two patients the aneurysm ruptured into the right ventricular cavity. In the third case, in which the lesion was associated with coarctation of the aorta, no communication was shown between the aorta and other cardiac chambers. The characteristic echocardiographic features of the right coronary sinus aneurysm (either with or without rupture in the right ventricular cavity) consist of: 1) The presence of echoes (referable to the right aortic cusp pattern of motion) encroaching the right ventricular outflow tract. 2) The presence of the same box-shaped echoes at a low level of the left ventricular cavity, which seem to "cross" the septum (from the left to the right ventricular outflow tract). These images would reflect the "prolapse" of the affected cusp. Other common, but non-specific echocardiographic features of the lesion are: an indistinct contour of the anterior wall of the aortic root (probably due to dilatation of the right coronary sinus) and systolic indentations on the right anterior aortic cusp echoes.

Adult↗
PubMed1976

[Echocardiographic diagnosis of the dissection of the thoracic aorta].

Nine patients with aortic root dilatation without dissection and four patients with a dissecting aneurysm of the ascending aorta were studied with single-plane echocardiography. Previously reported echocardiographic findings, which have been shown to be similar in these two groups of patients, are confirmed. In addition to (a) aortic root dilatation, (b) thickening of the anterior and/or the posterior aortic wall, and (c) the multiple parallel echoes within the widened aortic walls, which are all considered to be not specific signs of dissection, the authors outline the presence of some specific echocardiographic patterns in patients with a dissecting hematoma of the ascending aorta. These include: 1) the loss of contiguity between the inner borders of the anterior aortic wall and the interventricular septum when the dissection is confined to the anterior wall of the aorta; 2) the loss of contiguity between the inner and/or outer borders of the posterior aortic wall and the mitral anulus if the hematoma extends to the posterior wall of the aorta.

Adult↗
PubMed1975

Fate of coronary collateral circulation after aorto-coronary saphenous vein bypass grafts.

The pre- and postoperative patterns of coronary artery collateral circulation have been studied in 34 patients who had saphenous vein bypass grafting. When the graft remained patent homocoronary collaterals could not be visualized after operation, but new intercoronary anastomoses frequently developed to other diseased arteries. When the graft and the bypassed artery were both obstructed there was a high incidence (5 out of 11) of myocardial infarction despite good preoperative collaterals.

Aorta, Thoracic↗
PubMed1975

Haemodynamic events in right and left ventricle during angina induced by atrial pacing.

Atrial pacing to the point of angina or up to a maximum rate of 166/min was carried out in 37 patients during coronary angiography. In 9 patients with normal coronary arteries both the right and left ventricular end-diastolic pressures fell remained steady with increasing heart rate. The same response was observed in 14 patients with angiographically proven coronary artery disease. In the remaining 14 patients with provencoronary artery disease the end-diastolic pressure in the left ventricle rose at the point when the patient experienced angina. In 10 of this latter group there was a simultaneous rise in the right ventricular end-diastolic pressure. In 4 patients the rise in end-distolic pressure was seen in the left ventricle only. The haemodynamic events in the right ventricle during angina appeared in most cases to mimic the events occurring in the left ventricle. There was no correlation between the angiographic findings and the changes in end-diastolic pressure in the two ventricles during angina.

Angina Pectoris↗