Subacute left ventricular free wall rupture complicating acute myocardial infarction. Successful surgical repair with a sutureless technique.

The high mortality index related to surgical therapy with direct suture of rupture of left ventricular free wall following acute myocardial infarction, suggested we analyze and use alternative techniques. So we applied sutureless technique described by Padro to two patients. We used a Teflon patch fixed to the ventricular wall with a biocompatible synthetic glue, an ethyl-2-cyanoacrylate monomer, without any direct suturing of the infarcted myocardium. The two patients survived the operation and were discharged from the hospital 12 and 14 days after surgery. The sutureless technique allows, in our opinion, a more confident and safe aggressive attitude to subacute left ventricular free wall rupture.

[Doppler echocardiographic evaluation of functional parameters of mechanical and biological valve prostheses]. / Valutazione tramite ecocardiografia-Doppler dei parametri funzionali di protesi valvolari meccaniche e biologiche.

We studied and compared functional parameters in 314 valvular prostheses. The following parameters have been calculated: mean transvalvular gradients for aortic and mitral prostheses and functional area by Pht (pressure half time) for mitral prostheses. All patients with important depression in myocardial function, tachycardia or malfunctioning prostheses were excluded. 173 prostheses were in aortic position and 141 in mitral position. Mitral prostheses were: 31 biological and 110 mechanical. We subdivided mechanical prostheses in monoleaflet (Omnicarbon, Sorin-Carbocast and Allcarbon, Medtronic, Bjork-Shiley) and bileaflet (Sorin-Bicarbon, St. Jude). These three groups were compared: mean transvalvular gradients and area showed no differences. Aortic prostheses were: 33 biological and 140 mechanical; mechanical prostheses were subdivided in two groups: monoleaflet (Sorin Allcarbon e Carbocast, Bjork-Shiley, Medtronic, Omnicarbon) and bileaflet (Sorin-Bicarbon, St. Jude). Mean transvalvular gradients of these three groups were compared within each group for every size: bileaflet prostheses demonstrated inferior gradients than biological and monoleaflet for 19-21 and 23 sizes; in superior sizes there were no significant differences. Further analysis showed a significant correlation among gradients and body surface area in the 21 size prostheses (p = 0.004). Bileaflet prostheses in this subgroup showed less increase in mean gradient with surface area than mechanical and biological ones.

[Serial Doppler echocardiography follow-up studies in the postoperative evaluation of severe pulmonary hypertension following surgery for mitral and mitral-aortic defects]. / Valutazione postoperatoria del comportamento della ipertensione polmonare grave nei vizi mitralici e mitroaortici tramite controlli seriati con ecocardiografia Doppler.

Between January 1987 and December 1991 26 patients with mitral and mitro-aortic disease and severe pulmonary hypertension (> or = 60 mmHg) were subjected to surgery. In 22 patients we have studied systolic pulmonary pressures by echocardiography-Doppler examination at 3-6 and 12 months from surgery. We noticed a decrease in pulmonary pressure values in all patients within 3 months from surgery (mean values pre-op 75 +/- 12.14; mean values post-op 42 +/- 11.26); within 6 months from surgery physiological values were reached in all patients (mean values 35 +/- 5.3). We have further divided patients in two subgroups: group A with pulmonary pressures superior or equal to 80 mmHg (mean values 90.00 +/- 17.32) and group B With pressure values between 60 and 79 mmHg (mean values 69.12 +/- 3.64). The first Doppler evaluation demonstrated a greater decrease in group B (mean values 37.8 +/- 6.5 versus 57 +/- 12.4); at the second control there was no statistically significant difference between the two groups (group A 36 +/- 5.48, group B 33.33 +/- 5.37). The only two operative deaths were caused by the pre-op cardiogenic shock. There has been no late mortality among survivors, 22 in NYHA Class I and 2 in NYHA Class II. Pulmonary hypertension decreases after surgery independently of the adopted procedure (replacement, repair or lysis).

Surgical management of intracardiac myxomas. A 16-year experience.

Twenty-six patients with an intracardiac myxoma underwent surgical resection at our institution from 1977 through 1992. Left atrial myxoma was diagnosed in 22 patients, left ventricular in 1, right atrial in 2, and right ventricular in 1. Six patients were asymptomatic; preoperative symptoms included dyspnea, arrhythmias, embolic episodes, and syncope. The diagnosis was established with transthoracic echocardiography in all cases but one. Surgery was performed in all cases with the aid of cardiopulmonary bypass with moderate hypothermia and cold crystalloid cardioplegia. One patient with a left ventricular myxoma died in a comatose state during the immediate postoperative period. Long-term clinical and echocardiographic evaluation was performed in 19 patients; results were excellent (all the patients were in New York Heart Association functional class I or II), and no recurrences were documented. The clinical characteristics, diagnostic methods, and surgical approach are presented and discussed.

Emergency surgical treatment for total left main coronary artery occlusion. A report of 2 cases.

Treatment of total left main coronary artery occlusion is rarely reported (84 chronic and acute cases in the world literature), due to the high mortality rate from massive myocardial infarction. Acute occlusions have been treated with intracoronary streptokinase, with percutaneous transluminal coronary angioplasty, or with both. To date, there has been no report of successful surgical revascularization in an acute case. We present 2 cases of surgically treated patients who survived total left main coronary artery occlusion that appears to have been acute, or acutely evolving. Both patients had an 80% or greater stenosis of the right coronary artery, yet have remained in New York Heart Association functional class I or II postoperatively. We attribute this not only to the aggressive surgical approach, which enabled reperfusion to be achieved within 2 hours of total occlusion, but to the protective effect in these patients of right coronary-to-left anterior descending collaterals.

[Acute surgically-treated complications of myocardial infarct. Clinical experience and discussion of surgical indications]. / Le complicanze acute di interesse chirurgico dell'infarto miocardico. Esperienza clinica e discussione dell'indicazione chirurgica.

Post-infarction free-wall, papillary muscle and septal myocardium rupture yields a lowering mortality, not only due to the improved surgical technique but also to a more careful selection of surgical candidates. The value of pericardial decompression in cases of free-wall rupture is discussed. Echocardiographic evidence of blood in the pericardium after a myocardial infarction is not a direct indication for a diagnostic sampling, decompression or surgery. Pericardiocentesis is not a risk-free procedure and should be limited to patients with life-threatening acute tamponade. Clinical results of 34 patients operated upon for myocardial rupture, regardless of adopted technique or timing of surgery, confirm that the decision about a patient's operability should follow a careful evaluation of the following risk factors in this order: infarct size, age, cardiogenic shock, multiorgan failure, rupture site, cardiac failure and associated diseases.

A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery.

We have developed a new system for the production of autologous platelet-rich plasma and red blood cell concentrates to be used in autologous transfusion support of cardiac surgery patients. In 15 operations no homologous blood products were required. Costs were diminished since with the same harness it was possible to carry out the intraoperative blood salvage and concentrate the erythrocytes contained in the oxygenator and its lines. Indirect costs were also reduced since no infective complication was observed due to homologous blood products.

[Catheter embolism. Method of bloodless extraction]. / Embolie da cateteri. Metodi di estrazione incruenta.

A detailed review and analysis of world literature on the techniques employed for the retrieval of polythene catheter fragments, metal spindles or Pudenz catheters from the heart or large vessels is presented. Non-surgical retrieval techniques are discussed on the basis of 174 cases reported in the literature. 2 personal cases of the retrieval of foreign bodies from the heart using a Deyhle-Seubert catheter are presented.

Removal of iatrogenic foreign bodies within cardiac chambers with a new snare catheter.

A technique for extracting an embolized venous catheter lodged in the pulmonary artery is described. A Deyhle-Seuberth catheter, which is generally used to excise gastrointestinal polyps, was used successfully to accomplish the extraction.

[Left endoatrial myxoma. Notes on a case]. / Mixoma endoatriale sinistro. Considerazioni su un caso.

A case of left endoatrial mixoma, ecocardiographically discovered and successfully operated, is reported. The usefulness of ecocardiography, especially to discover intracardiac masses, is considered.

[Anti-arrhythmic effects of cardioplegic myocardial protection]. / Effetti antiaritmici della protezione miocardica cardioplegica.

Cardioplegia gave excellent results in a preliminary series of 33 cases in which it was used during surgery. The fact that a sinus rhythm was re-established at the end of extracorporeal circulation in patients in atrial fibrillation suggests that it exerts an antiarrhythmic action at the atrial a level.

[Experience with lithium pacemaker in the University of Genova (Italy) (author's transl)]. / La nostra esperienza con gli stimolatori cardiaci al litio.

The Authors report on their own experience of 77 lithium pacemaker implanted between 1974 and September 1977 in the Centre of Cardiac Surgery of the University of Genova (Italy). Only one generator has been replaced till now because of liquid infiltration. Rate variations in pacemaker marketed by Sorin were studied, considering the test-stand rate the first control and the following rate controls; the reliability of this parameter was confirmed.