Biomedical subjects
Publications and source records attributed to A Iacono.
Atrial septal aneurysm is a cardiac abnormality with thromboembolic potential; in patients with this lesion and parameters of risk of embolic events long-term anticoagulant therapy is indicated. A clinical case of a young woman with atrial septal aneurysm and low risk parameters of cardioembolic stroke was presented.
Low-dose estrogen replacement therapy should be recommended to post-menopausal women, especially if they suffer from circulatory disorders, because it significantly reduces cardiovascular risk. Low-dose estrogens favourably affects lipid profile, without causing a significant increase of thrombotic risk: atherosclerosis is therefore prevented. Estrogen can augment coronary flow by the relaxation of vascular smooth-muscular cells. Finally, estrogen can improve left ventricle systolic and diastolic function, delaying the physiological aging process.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Microchimerism in lung allograft recipients was studied in the autopsies of nine female recipients of male lung grafts who had survived for more than 1 month after transplantation. Using a Y chromosome-specific probe tissues were studied for the presence of donor cells that had migrated beyond the graft itself. They were quantitated by cell counting to give absolute numbers of cells per organ volume. While donor cells were disseminated throughout the body, their numbers were small. These absolute numbers should be studied in a larger group of recipients to determine if they correlate with prognosis and the development of bronchiolitis obliterans.
Two groups of children with acute lymphoblastic leukemia or non-Hodgkin lymphoma, treated with anthracyclines (ANT), were studied: group I, consisting of 10 patients, with coenzyme Q10 (CoQ) therapy; group II, consisting of 10 patients without CoQ therapy. The ANT cumulative dose was 240 +/- 20.0 mg/m2 in group I and 252.0 +/- 20.1 mg/m2 in group II. Echocardiographic study was performed at the beginning, at the cumulative dose of 180 mg/m2 and at the end of therapy with ANT. Percentage left ventricular fractional shortening (%LVFS) decreased from baseline (40.36 +/- 4.6) to end value (35.82 +/- 5.02) (P < 0.05) in group I; %LVFS decreased from baseline (39.89 +/- 4.37) to end value (33.43 +/- 3.46) (P < 0.002) in group II. Interventricular septum wall thickening decreased only in group II from baseline (46.10 +/- 10.1) to end therapy (27.00 +/- 18.54) (P < 0.01). Septum wall motion abnormalities were detected only in 2 patients of group II. These data demonstrate a protective effect of CoQ on cardiac function during therapy with ANT.
The authors report their experience on etiological and clinical aspects of infective endocarditis (IE). A series of 182 consecutive patients, including 83 cases of medical IE, 73 cases of IE in intravenous drug abusers (DA), 22 cases of IE on late prosthetic valves and 4 cases of IE on early prosthetic valves were evaluated since 1976. Medical IE occurred frequently in the elderly patients and in most of the cases (80%) involved natural valves with underlying abnormalities, either rheumatic (42%) or degenerative (33%) or malphormative (25%). Pre-existing valvular pathology was not needed for IE in DA, occurring in 13%, mainly due to a previous IE. In most of the cases IE in DA was a staphylococcal IE (80%) and a right-sided IE (77%). Streptococci were frequent agent both in medical and late prosthetic valves IE (55%): however, a wide pattern of microorganisms, including "unusual" pathogens like nutritionally variant Streptococci, Haemophylus parainfluenzae, Haemophylus paraphrophylus, Coxiella burnetii and the so-called "non pathogen microorganisms" (e.g. Neisseria sicca) was identified as etiological agent. As regards the clinical approach and diagnosis, the Authors underline some atypical clinical presentations of IE: the pulmonary presentation, occurring in right-sided IE, mainly in DA; the neurological presentation, suggesting staphylococcal etiology and left-sided IE; the vasculitis presentation, miming connective tissue diseases; the cardiac presentation, observed in aortic localization (1 case). One or more severe complications occurred in 65% of the patients, contributing to adverse outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)
This report shows the importance of non-invasive techniques in infective endocarditis (IE) diagnosis. ECG is quite specific in identifying perivalvular extension of infection when conduction system disease is demonstrated but has a low degree of sensitivity overall. Our casuistry (76 patients with IE) confirms the literature data about the great importance and the utility of transthoracic and transesophageal echocardiography to detect vegetation presence or complications as abscesses or valvular leaflet perforations. Therefore, these techniques are widely applied to predict major clinical events as embolism and death or to suggest a surgical therapy. Nuclear medicine studies play a minimal role. Magnetic resonance imaging appears to be an effective tool in this setting; however, because of a paucity of clinical data, its precise utility has not yet been determined.
This paper reviews the role of echocardiography in tricuspid valve repair by analyzing the results of three clinical studies. The first investigation was performed for assessing the outcome of two surgical techniques in two groups of patients who underwent De Vega's suture annuloplasty or Carpentier ring implantation. The patients were studied by color Doppler echocardiography after a mean follow-up of 28.7 +/- 11.1 months. The results showed lower degree of tricuspid valve regurgitation in the group of patients who underwent De Vega annuloplasty. The second study demonstrates a new application of transesophageal echocardiography (TEE) for optimizing tricuspid valve annuloplasty. Twenty-three patients with moderate to severe tricuspid regurgitation underwent De Vega's annuloplasty. After cardiopulmonary bypass the tension on the suture was adjusted until the surgeon could not feel any regurgitant jet by the intraatrial palpation; subsequently, the tension was further adjusted under guidance of TEE. The data obtained by the traditional palpation were compared with the data obtained by TEE. A significant reduction of residual tricuspid regurgitation was obtained by TEE when compared to the data obtained by intraatrial palpation. The results showed that the use of TEE was able to optimize the De Vega's annuloplasty by reducing residual tricuspid regurgitation. The third study investigated tricuspid valve regurgitation commonly observed after orthotopic cardiac transplantation (HTX). Aim of the study was to assess the degree of regurgitation and its etiology. Twenty-five patients undergoing HTX were studied intraoperatively by TEE. The results showed that tricuspid regurgitation occurs in most patients immediately after HTX; it is correlated to the ratio recipient-donor right atrium; surgical techniques which reduce the recipient atrium may decrease the occurrence and the degree of tricuspid regurgitation. The above mentioned clinical investigations showed a many-sided role of TEE in tricuspid valve repair. It provides not only a useful diagnostic tool for evaluating residual regurgitation, but it may actively guide the surgical procedures and contribute to improve the surgical technique.
A survey by questionnaire to assess the daily practice of the antibiotic prophylaxis of infective endocarditis by physicians attending post-graduate schools of the Institutes of Oral Surgery and Stomatology (Group A n = 83) and Cardiology (Group B n = 46) of the Second University of Naples has been conducted. They were asked about dental procedure and cardiopathies that require prophylaxis for infective endocarditis, the relationship between infective endocarditis and rheumatic disease and the provision of antibiotic. Extraction of tooth and dental and oral surgery have been reported as the most risky procedures. Moreover provision of antibiotic prophylaxis was suggested to patients not at risk (pacemaker or coronary artery bypass), and was not suggested in high risk conditions (mitral valve prolapse with regurgitation and hypertrophic cardiomyopathy). Most of the 50-60% practitioners usually start the prophylaxis 24-48 hours before the procedure and prolong it for 48-72 hours. These results underline the need for improvement of the knowledge for the antibiotic prophylaxis of infective endocarditis.
Shy-Drager syndrome is a very rare disease affecting the autonomic nervous system. Usefulness of beta-adrenergic chronic therapy has already been focused in these cases. Ambulatory blood pressure monitoring may help to study the cardiocirculatory adaptation in Shy-Drager syndrome patients.
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The authors carried out a perspective study to determine the frequency of silent ischemia (SI), in 50 consecutive patients with end stage renal failure, during dialysis by Holter monitoring. Twenty patients had SI. The number of cardiovascular risk factors, principally diabetes, smoking and the underlying renal disease was related to ischemic events. Dialysis may predispose to and facilitate the detection of myocardial ischemia by the simultaneous presence of hypotension, hypovolemia, hypoxia and tachycardia. Holter monitoring may allow the detection of ischemic events and the identification of a subgroup of dialytic patients with a high cardiovascular risk.
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A 50 year old woman with no evidence of structural heart disease was referred for ectopic incessant repetitive atrial tachycardia uncontrolled by medical therapy. Intracavitary and transesophageal simultaneous recordings revealed the earliest atrial electrical activity to be located in the left atrium. Intraoperative electrophysiologic mapping demonstrated that the site of earliest atrial activation was in a small diverticulum of the left atrial appendage. Excision of the appendage and isolation of left atrium was carried out with restoration of sinus rhythm. The patient was arrhythmia-free till 24 months later. Surgical treatment appears to be an effective therapeutic option for drug-resistant ectopic atrial tachycardia.