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1.
Acta Biomed Ateneo Parmense ; 72(3-4): 69-74, 2001.
Article in English | MEDLINE | ID: mdl-11889910

ABSTRACT

We evaluated our experience with the use of the radial artery as a key conduit in re-do coronary artery bypass surgery to determine the safety and efficacy and to compare this procedure to re-operations performed without the radial artery. Sixty-eight patients operated on re-do revascularization were studied: mean age was 67 years; 42 patients were in CCS III (62%) and 18 in CCS IV (26%); past myocardial infarction occurred in 12 patients (18%). We performed 116 anastomoses in all 68 patients (mean no. anastomoses/patient 1.7). Perioperative mortality was 4.4%. Three patients (4.4%) showed a transient postoperative low cardiac output syndrome; four (5.8%) had a respiratory failure and an acute renal failure occurred in 2 patients (2.9%). Four patients (5.8%) required re-operation for bleeding. The comparison of the radial re-do group (27 patients) with the non-radial re-do group (41 patients) showed a lower mortality and morbidity in the former, even if p value was not significant. We conclude that the use of the radial artery in re-do coronary operations is safe, effective, allowing an additional conduit choice and may avoid late vein graft failure.


Subject(s)
Coronary Artery Bypass/methods , Radial Artery/transplantation , Aged , Female , Humans , Intraoperative Complications/mortality , Male , Middle Aged , Postoperative Complications/epidemiology , Reoperation
2.
Acta Biomed Ateneo Parmense ; 72(3-4): 79-81, 2001.
Article in English | MEDLINE | ID: mdl-11889912

ABSTRACT

UNLABELLED: The aim of this study IS to determine surgical results after surgical mitral valve repair in ischaemic mitral regurgitation. MATERIALS AND METHODS: Between January 1999 and June 2000, 64 patients (5.1% of overall patients) underwent myocardial revascularization and mitral valve surgery. A Cosgrove-Edwards mitral annuloplasty ring was used in 59 cases (92.2%). Average patient age was 64.3 +/- 12.4 years (38 males, 21 females). Average degree of mitral regurgitation was 2.8 +/- 0.6. Average NYHA class was 3.5 +/- 0.5. Average ejection fraction (EF) was 40 +/- 12.5 percent. RESULTS: Post-operative 30-day mortality was 3.4% (2 patients). The follow-up was complete for 95 percent (mean 20.4 +/- 4.8 months for patients) and data showed an improvement of NYHA class (mean value 1.8 +/- 0.2) (p = 0.01) and ejection fraction (mean value 51.7 +/- 10.2) (p = 0.05) with residual mitral regurgitation value of 0.6 +/- 0.7. CONCLUSIONS: Mitral valve repair in coronary artery disease improves left ventricular function, quality of life and survival rate with low operative risk. Perioperative transesophageal echocardiography has a central role in surgical decision making.


Subject(s)
Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/surgery , Myocardial Ischemia/complications , Myocardial Ischemia/surgery , Myocardial Revascularization/methods , Cardiac Surgical Procedures/methods , Echocardiography, Transesophageal/methods , Female , Follow-Up Studies , Humans , Intraoperative Care , Male , Middle Aged , Mitral Valve Insufficiency/diagnosis , Myocardial Ischemia/diagnosis , Postoperative Complications/mortality , Preoperative Care
3.
Acta Biomed Ateneo Parmense ; 66(1-2): 53-5, 1995.
Article in Italian | MEDLINE | ID: mdl-7502614

ABSTRACT

The surgical treatment of pulmonary embolectomy is currently indicated for acute massive obstruction of the pulmonary artery with severe haemodynamic failure and, as in this case, when medical treatment with anticoagulants or thrombolytic drugs is contraindicated. In this work, the Authors focus on the technique of unilateral pulmonary embolectomy through a median sternotomy; this approach allowed an easier and safer embolectomy without extracorporeal circulation.


Subject(s)
Embolectomy/methods , Extracorporeal Circulation , Postoperative Complications/surgery , Pulmonary Embolism/surgery , Emergencies , Female , Humans , Middle Aged , Postoperative Complications/diagnosis , Pulmonary Embolism/diagnosis
4.
Acta Biomed Ateneo Parmense ; 66(5): 191-4, 1995.
Article in Italian | MEDLINE | ID: mdl-8928581

ABSTRACT

We report a case of a 74 old man presenting unstable angina and history of previous myocardial infarction. Coronary angiography showed significant stenoses of the left main and right coronary arteries and saccular aneurysm of the left anterior descending coronary artery. The patient underwent surgical treatment consisting in coronary artery bypass grafts and aneurysm resection. This procedure appears indicated, in author's opinion, when coronary aneurysm is saccular as in the described case.


Subject(s)
Coronary Aneurysm/surgery , Aged , Angiography , Coronary Artery Bypass , Coronary Disease/surgery , Humans , Male
5.
Acta Biomed Ateneo Parmense ; 66(5): 195-201, 1995.
Article in Italian | MEDLINE | ID: mdl-8928582

ABSTRACT

To determine if autotransfusion of unwashed shed mediastinal blood led to a reduction in the postoperative banked blood requirements were analyzed in a prospective study 82 patients undergoing myocardial revascularization during 1994 at Cardiovascular Surgery Center of Parma, randomized to receive (ATS) or not (noATS) the system. No differences were noted between two groups in terms of clinical parameters; likewise the operative characteristics were similar for the two groups. The mean 24-hours postoperative blood loss was 719.5 +/- 196 ml in the ATS group and 843 +/- 292 ml in the nonATS group (p = 0.027); the mean volume autotransfused in the ATS group was 416 +/- 167 ml. There were no reoperations for bleeding. In the nonATS group 65.8% of patients required postoperative homologous transfusions compared with 41.5% in the ATS group (p = 0.05). The mean immediate and 24-hour postoperative hemoglobin values were similar in the two groups, but at hospital discharge were 21.1 +/- 1.4 g/dL in the nonATS group and 11.3 +/- 1.4 g/dL in the ATS (p = 0.015). By logistic stepwise multiple analysis were identified as risk factors for banked blood requirement the variables: age, preoperative blood drawing patient, blood drawing before institution of cardiopulmonary bypass and postoperative blood loss. Non use of ATS was not a significant incremental risk factor for banked blood requirement, furthermore we think that use of ATS system is a primary blood volume support and confers to reduce homologous transfusions and their related complications after cardiac operations.


Subject(s)
Blood Transfusion, Autologous , Mediastinum/surgery , Myocardial Revascularization , Suction , Aged , Female , Hemoglobins/analysis , Humans , Male , Middle Aged , Retrospective Studies
6.
Acta Biomed Ateneo Parmense ; 66(5): 209-15, 1995.
Article in Italian | MEDLINE | ID: mdl-8928584

ABSTRACT

The authors explain their experience about the combined correction of cardiac pathology and infrarental aortic aneurysm repair. Seven patients of mean age of 63 years underwent simultaneous myocardial revascularization (5 cases) or aortic valve replacement (2 cases) and abdominal aortic aneurysm repair with bifurcated vascular prosthesis (6 cases) and tubular prosthesis (1 case) between 1987 and 1995. Cardiac operation was performed first with a mean number of 2.4 coronary artery by-pass grafts, with a mean by-pass time of 51 min, and a mean abdominal aortic cross-clamp time of 46 min. The mean total operating time was 231 min. All patients were managed postoperatively in the cardiac intensive care unit with a mean duration of 2.5 days and were transfused with a mean of 5 units of donor blood. The mean postoperative hospitalization was 9 days. One patient died for complication of postoperative myocardial infarction. The authors conclude that combined cardiac operation and abdominal aortic aneurysm repair is feasible in carefully selected patients.


Subject(s)
Aneurysm/physiopathology , Aneurysm/surgery , Aorta, Abdominal/physiopathology , Aorta, Abdominal/surgery , Coronary Artery Bypass , Heart/physiopathology , Aged , Blood Transfusion , Coronary Disease/physiopathology , Coronary Disease/surgery , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies
7.
Int Angiol ; 12(4): 383-6, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8207317

ABSTRACT

The prophylactic deep venous antithrombotic efficacy of a low molecular weight heparin (LMWH) was compared with traditional unfractionated calcium heparin in 39 patients submitted to cardiac surgery. The patients were allocated at random to receive either LMWH-Fluxum 3200 IUaXa daily (Group A: 20 patients) or calcium heparin 5000 IU three times daily (Group B: 19 patients). Both treatments were started on the first day after surgery and continued over the fourth postoperative days. One or more risk factors for deep venous thrombosis in addition to the cardiac pathology were present in all the patients of group A and in 13 (72.2%) of group B. Mean times of surgery, blood loss during the perioperative period and number of blood units transfused in both groups were not statistically significant. The deep venous system was investigated by continuous wave Doppler and real time colour Echotomography. No evidence of thrombosis was detected in the two groups. Side effects and subcutaneous hematomas were present in only four patients of group B. Both drugs showed good tolerance, provoking no variations of the main laboratory parameters. We conclude that Fluxum (LMWH) for the efficacy and convenience given by a single daily dose, could represent an alternative choice in the prevention of deep venous thrombosis in cardiac surgery.


Subject(s)
Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Heparin/therapeutic use , Myocardial Revascularization , Postoperative Complications/prevention & control , Thrombophlebitis/prevention & control , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Risk Factors , Thrombophlebitis/epidemiology
8.
J Cardiovasc Surg (Torino) ; 33(3): 311-4, 1992.
Article in English | MEDLINE | ID: mdl-1601914

ABSTRACT

This study was undertaken to evaluate the efficacy of hypothermic extracorporeal circulation for cerebral protection in 17 patients having simultaneous carotid endarterectomy and cardiac operations. The cardiopulmonary by-pass (CPB) was conducted using total hemodilution. The body temperature was cooled to 25 degrees C and the heart was arrested with cardioplegic solution. The carotid endarterectomy was performed first followed by the cardiac operation. No neurological or cardiac complications occurred. These results support the reliability of hypothermic cardiopulmonary bypass as a method of providing cerebral protection during simultaneous cardiac and carotid surgical procedures.


Subject(s)
Brain Ischemia/prevention & control , Carotid Arteries/surgery , Endarterectomy/methods , Extracorporeal Circulation , Hypothermia, Induced , Intraoperative Complications/prevention & control , Aged , Aortic Valve , Coronary Artery Bypass , Female , Heart Valve Prosthesis , Humans , Male , Middle Aged , Postoperative Complications/epidemiology
9.
Minerva Cardioangiol ; 37(6): 289-97, 1989 Jun.
Article in Italian | MEDLINE | ID: mdl-2812446

ABSTRACT

Between January 1982 and December 1986, 62 patients (59 male and 3 female) ranging in age from 37 to 69 years (mean 53) underwent resection of postinfarction left ventricular aneurysm. The indication for operation was angina in 23 cases (37%), congestive heart failure (CHF) in 7 (11.2%), angina and CHF in 29 (46.8%), rupture in 1; 2 patients were low symptomatic. Ventricular arrhythmias were present in 6 (9.7%) cases and previous systemic embolism in 4 (6.4%). Forty-seven (75.8%) patients had lesions of three coronary arteries with involvement of left main coronary artery in 4 cases; 10 (16.1%) had lesions of two vessels [left anterior descending (LAD) and/or right coronary artery]; 4 (6.4%) had only LAD artery involvement, and 1 had no significant coronary artery stenoses. Left ventricular ejection fraction (EF) was less than 0.30 in 22% of cases, between 0.30 and 0.40 in 25.4% and greater than 0.40 in 50%. The location of the aneurysm was anterolateral or apical (83.8%), posterior (14.5%) and lateral (1.6%). Left ventricular aneurysmectomy with myocardial revascularization was performed in 61 patients (bypass/patient = 2.7), with ventricular septoplasty in 20 and concomitant mitral valve replacement in 3 patients. LAD was grafted in 59.6% of anterior aneurysm. Operative mortality (30 days) was 4.8%, the late mortality, with a follow-up between 12 and 72 months (mean 38), was 6.7% and the actuarial 5 year survival rate was 85% (91% without operative mortality). In our experience, despite no evidence of any operative risk factors, no improvement was noted in radionuclide left ventricular ejection fraction in patients undergoing aneurysmectomy with ventricular septoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Heart Aneurysm/surgery , Myocardial Infarction/complications , Adult , Aged , Evaluation Studies as Topic , Female , Follow-Up Studies , Heart Aneurysm/etiology , Humans , Male , Middle Aged
10.
J Cardiovasc Surg (Torino) ; 29(6): 663-5, 1988.
Article in English | MEDLINE | ID: mdl-3209609

ABSTRACT

A case of right atrial hemangioma as a rare tumor of the heart is reported. Because of its single, pedunculated mass, surgical excision of the tumor resulted in the complete treatment. Histologically, it was classified as arteriolar type. The importance of recent non-invasive techniques to diagnose these tumors during life is emphasized.


Subject(s)
Heart Neoplasms/surgery , Hemangioma/surgery , Echocardiography , Heart Atria , Heart Neoplasms/diagnosis , Heart Neoplasms/pathology , Hemangioma/diagnosis , Hemangioma/pathology , Humans , Male , Middle Aged
11.
J Cardiovasc Surg (Torino) ; 28(3): 341-2, 1987.
Article in English | MEDLINE | ID: mdl-3495538

ABSTRACT

The case is described of a fifty year old man who underwent coronary bypass surgery using the circular sequential vein graft technique. At follow-up study (6 months after operation), despite his asymptomatic status, the effort test revealed antero-lateral myocardial ischemia. A coronary angiography showed a 90% proximal stenosis of the graft at 1.5 cm from the aortic anastomosis. The patient was reoperated on and the circular graft was reconstructed. Despite the severe stenosis this technique of myocardial revascularization has developed intercoronary anastomoses, improving the cardiac contractility and avoiding further clinical complications.


Subject(s)
Coronary Artery Bypass , Graft Occlusion, Vascular/surgery , Humans , Male , Middle Aged , Reoperation
12.
Acta Biomed Ateneo Parmense ; 58(3-4): 105-11, 1987.
Article in Italian | MEDLINE | ID: mdl-2961181

ABSTRACT

From March 1979 to December 1985 at Cardiac Surgery Department of Parma 1064 patients underwent myocardial revascularization. Of them, 82 (7.7%) with poor left ventricular function (ejection fraction less than 40%) were studied to evaluate the effects of coronary artery bypass grafting on surgical risk, survival, ventricular performance and late clinical status. Three vessels disease was present in 65.9% and severe stenosis of left main coronary artery in 21.9% of patients. There were 74 (90.2%) patients with a history of previous myocardial infarction and 8 (9.75%) with congestive heart failure. Mean ejection fraction was 32.21 +/- 3.6%. On biplane left ventricular angiography 60 (73.2%) cases had two or more akinetic segments and 22 (21.9%) only hypokinesia. Operative mortality rate was 4.9%; perioperative myocardial infarction occurred in 5 patients (6.2%). Mean follow-up was 37.64 +/- 9.23 months and survival rate, including operative mortality, was 91.3%. Among the long-term survivors 89.04% are asymptomatic and in 49% there was a significantly improvement of preoperative left ventricular ejection fraction. We conclude that myocardial revascularization should be performed also in patients with left ventricular dysfunction, because of improvement of quality of life.


Subject(s)
Coronary Artery Bypass , Coronary Disease/surgery , Myocardial Contraction , Female , Follow-Up Studies , Humans , Male , Premedication , Retrospective Studies , Stroke Volume
13.
Acta Biomed Ateneo Parmense ; 58(3-4): 99-103, 1987.
Article in Italian | MEDLINE | ID: mdl-2961187

ABSTRACT

Digital subtraction angiography (DSA) has became a common diagnostic procedure in the investigation of patients with cerebrovascular disorders. In these report is described a series of 80 cases previously examined in 8 different department of radiology, 59 with IV.DSA and 21 with IA.DSA. Thirty per cent of IV.DSA images were judged to be technically inadequate, so that further evaluations with conventional angiography have been needed, and in 3 patients (5.0%) the IV.DSA diagnosis was overturned. The authors recommend intraarterial digital subtraction angiography for evaluation of extracranial carotid occlusive disease always resulted the definitive diagnostic procedure in their experience.


Subject(s)
Carotid Artery Diseases/diagnostic imaging , Subtraction Technique , Carotid Artery Diseases/surgery , Humans , Radiography
15.
Acta Biomed Ateneo Parmense ; 53(3): 139-45, 1982.
Article in Italian | MEDLINE | ID: mdl-6216701

ABSTRACT

Since 1975 to 1979 24 patients affected by acute infective endocarditis were operated of valvular replacement. All patients presented increasing cardiac failure unresponsive to medical treatment; 48% of the cases had positive blood culture. In 5 patients the infective endocarditis occurred on previously implanted prosthetic valve. Surgical findings consisted in rupture of chordae tendineae, vegetation ad perforation of valvular cusps. Prosthetic valvular replacement was performed in all cases using mechanical valve (22) or porcine heterograft 85). Surgical mortality was 8,3%, while late mortality occurred on 12.5% of cases. The diagnostic considerations, concerning this disease, the surgical results and long term management are discussed.


Subject(s)
Endocarditis, Bacterial/surgery , Adult , Aged , Aortic Valve , Endocarditis, Bacterial/mortality , Female , Heart Valve Diseases/mortality , Heart Valve Diseases/surgery , Heart Valve Prosthesis , Humans , Male , Middle Aged , Mitral Valve
16.
Acta Biomed Ateneo Parmense ; 53(5): 347-52, 1982.
Article in Italian | MEDLINE | ID: mdl-6220546

ABSTRACT

Authors describe the surgical technique for pulmonary embolectomy and review the cases of the patients undergoing such operation. On the basis of the obtained results, Authors think that the unsuccessful cases are mainly due to the very deteriorated preoperative clinical state of these patients and to associated illness. Authors believe that the familiarity with this kind of procedure and the prompt decision to perform it before a further worsening of the clinical conditions have a positive influence on its results and that surgical indication should not be limited to the patients in cardiac arrest, but instead extended to those cases showing rapid deterioration of the clinical state.


Subject(s)
Postoperative Complications/mortality , Pulmonary Embolism/surgery , Adult , Extracorporeal Circulation , Female , Heart Arrest, Induced , Humans , Hypothermia, Induced , Italy , Male , Methods , Middle Aged , Pulmonary Embolism/complications , Time Factors
19.
Acta Neuropathol Suppl ; 7: 119-21, 1981.
Article in English | MEDLINE | ID: mdl-6939216

ABSTRACT

Some pathological features of tumors arising primarily in the meninges are discussed on the basis of 412 surgically treated meningiomas during the period running from 1964 to 1978. Cases of meningeal sarcomas were not considered. Except for a few cases, pathology and clinical course have been generally in agreement. The incidence of histological types like meningotheliomatous, fibroblastic, angioblastic or atypical meningiomas has been verified in relation to sex, age and intracranial or spinal conventional locations. The problem of recurrencies has been studied either comparing the histological features with the first observation or comparing histopathological types with location and details of surgical procedure. Additional criteria like uni or multifocal origin of the tumors and histological features of the peri-lesional tissues, often harbouring small meningiomatous nests, have been taken into account.


Subject(s)
Meningeal Neoplasms/pathology , Meningioma/pathology , Brain Neoplasms/pathology , Female , Humans , Male , Meninges/pathology , Neoplasm Recurrence, Local/pathology , Orbital Neoplasms/pathology , Spinal Cord Neoplasms/pathology
20.
Ateneo Parmense Acta Biomed ; 51(2): 77-82, 1980.
Article in Italian | MEDLINE | ID: mdl-7213452

ABSTRACT

The early and long-term results using the polytetrafluorethylene (Gore-Tex) are reported. In 20 patients, 12 ilio-femoral bypasses, 10 femoro-popliteal and 2 aorto-subclavian bypasses have been performed; 5 of these patients underwent simultaneously femoro-popliteal bypasses with Gore-Tex and ilio-femoral bypasses with Dacron. Only once the Gore-Tex was used as patch. The results have been satisfactory. However, longer follow-up and many more patients are needed to determine if the Gore-Tex will be the substitute for the autogenous saphenous vein in peripheral vascular reconstruction.


Subject(s)
Arterial Occlusive Diseases/surgery , Blood Vessel Prosthesis , Polytetrafluoroethylene , Subclavian Steal Syndrome/surgery , Aged , Aorta/surgery , Female , Femoral Artery , Humans , Iliac Artery/surgery , Male , Middle Aged , Popliteal Artery/surgery , Subclavian Artery/surgery
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