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Biomedical subjects

A Mazzucco

Publications and source records attributed to A Mazzucco.

At least 217 records · Page 12Linked to original sources
PubMed1983

Progress in the surgical treatment of ventricular septal defect: an analysis of a twelve years' experience.

Two hundred sixty-seven patients underwent surgical closure of a ventricular septal defect (VSD) over a 12-year period between January 1, 1970 and December 31, 1982. In 152 patients (57%) an associated lesion was present complicating the treatment of the primary lesion: 7 patients had multiple VSDs and among those with single defects, 189 were large (unrestrictive). The median age was 5.2 years ranging from 1 month to 46 years. Sixty-nine were infants under 10 kg of weight. The 30-day operative mortality was 8.6% (23 cases). The main cause of death was a low output syndrome in 16 cases. Thirty-two variables have been collected and their relationship with the death of the patients has been analyzed with univariate and multivariate methods. Logistic analysis has identified the independent significant incremental effect on hospital mortality of low weight (P greater than 0.00001), early operative date (P greater than 0.00001), multiplicity of defects (P = 0.0008), presence of major associated lesions (P = 0.019); the large size of the defect was only probably significant (P = 0.18). Inspection of the nomograms, relating the probability of operative death to weight and age in patients with a large defect, shows that the risk is significantly higher in the 3 kg baby (median age 3.3 months), particularly if major associated lesions are present. In infants with multiple VSDs the risk of operation remains, at the end of 1982, significantly higher than in single defects. However, our data suggest that the risk of open correction in patients over 12 kg of weight approaches that of single VSD if concomitant lesions do not complicate the surgical treatment.

Adolescent↗
PubMed1983

Accessory tricuspid valve tissue causing obstruction of the ventricular septal defect in tetralogy of Fallot.

Among 61 heart specimens of tetralogy of Fallot with or without pulmonary atresia, four presented with an accessory tricuspid valve leaflet. This structure caused partial or almost complete obstruction of the ventricular septal defect. Depending on the morphology, the accessory tissue was classified into "mobile" or "fixed" types. The "mobile" variety was tethered by long chordae tendineae which permitted a wide excursion of the leaflet through the ventricular septal defect into the left ventricular outflow tract where it represented a potential cause of obstruction. The "fixed" variety was attached to the edges of the defect by short chordae which reduced considerably its movements. This type created a fixed obstruction of the ventricular septal defect without involving the subaortic left ventricular outflow tract. The precise morphology of the accessory tricuspid valve tissue is of considerable surgical significance. When mobile, the tissue must be resected at the time of surgical repair. When fixed it can be used as a suture anchorage during closure of the ventricular septal defect.

Adult↗
PubMed1983

Acute mitral regurgitation after blunt chest trauma.

We treated a case of isolated acute mitral incompetence due to complete transection of the anterior papillary muscle produced by blunt chest trauma. The excellent results obtained with conservative therapy suggest that this approach be used in other similar cases. The pertinent medical literature is reviewed.

Adolescent↗
PubMed1983

Experience with operation for total anomalous pulmonary venous connection in infancy.

Twenty patients presenting with total anomalous pulmonary venous connection (TAPVC) in infancy underwent cardiac repair. Four had associated major intracardiac anomalies (complex TAPVC) and 16 had isolated TAPVC. All patients with complex lesions died during or shortly after the operation; they all had pulmonary venous obstruction (PVO). The associated malformations were critical pulmonary stenosis (one case), multiple ventricular septal defects (VSDs) (one case), mitral atresia (one case), and asplenia syndrome with common atrioventricular valve, double-outlet right ventricle, and pulmonary stenosis (one case). Among the patients with isolated lesions there were two surgical deaths, both in infants less than 1 month of age, with severe PVO and subdiaphragmatic drainage. Statistical analysis of these data shows a strongly incremental risk of surgical death due to the presence of associated malformations. Analysis of just isolated TAPVC shows a possible incremental effect due to neonatal age (less than 1 month) and PVO, these two factors being not clearly separated. There have been no late deaths and no late complications among the 14 survivors followed from 7 months to 10 years (mean 44 months). An aggressive surgical approach regardless of the age, degree of pulmonary hypertension, and type of anatomic connection is advised for isolated TAPVC. Some caution is recommended for complex TAPVC, in which a much higher risk is anticipated, particularly when a palliative pulmonary vein-to-left atrium anastomosis is performed.

Evaluation Studies as Topic↗
PubMed1983

Successful repair of symptomatic cor triatriatum dexter in infancy.

Cor triatriatum dexter is a rare cardiac malformation, usually diagnosed incidentally at operation or necropsy. We report the case of a 5-month-old infant, severely symptomatic, who underwent correction of a highly obstructive cor triatriatum dexter, with multiple anomalies of the systemic venous return and a large interatrial communication. This appears to be the first case of successful repair of this anomaly during infancy.

Angiocardiography↗
PubMed1982

Pregnancy in patients with a porcine valve bioprosthesis.

Seven patients who became pregnant after valve replacement with a Hancock bioprosthesis were followed up during 8 pregnancies. Six had undergone isolated mitral valve replacement, and 1 had mitral and aortic valve replacement. Their age at the time of operation ranged from 14 to 31 years (average 24); delivery occurred 21 to 88 months (average 51.3) after valve replacement. All women were in sinus rhythm at the time of gestation, and administration of oral anticoagulants was avoided in all. No embolic episodes occurred either after operation or during pregnancy, labor, or puerperium. The only major complication during pregnancy was cardiac failure in 1 patient, associated with onset of atrial fibrillation. Four women had vaginal delivery and 3 required cesarean section. All but 1 delivered a normal, healthy baby. One premature infant died soon after birth because of respiratory distress. No maternal or fetal hemorrhagic complications were observed. One patient died 3 months after delivery in severe heart failure caused by diffuse calcification of both mitral and aortic xenografts. Another women underwent successful reoperation soon after the second pregnancy because of calcific stenosis of the mitral porcine valve. It is concluded that (1) bioprosthetic valves can be considered the most suitable devices employed in women of childbearing age because anticoagulants can be avoided, therefore eliminating the risks related to inappropriate administration of oral anticoagulants as well as the hazards associated with the potential teratogenic effect of coumarin drugs; and (2) pregnancy might favor calcification of porcine heterografts, leading to bioprosthetic failure. Until further data are available to support this suspicion, close clinical and echocardiographic follow-up study of these patients is recommended after pregnancy.

Adolescent↗
PubMed1982

Right ventricular myxoma: review of the literature and report of two patients.

The cases of 2 patients with right ventricular myxoma are reported, together with a review of the literature. In both patients the ultimate diagnosis was reached by means of angiocardiography, which revealed large filling defects in the right ventricle. In 1 patient, cardiac catheterization failed to record a transpulmonary gradient. Echocardiography, performed after hemodynamic investigation in both patients, revealed the usual pattern of abnormal echoes moving from the right ventricular cavity to the right outflow tract during the cardiac cycle. In both patients the tumor was successfully excised through a right atrial approach. This approach was preferred to the right ventriculotomy because it provides adequate surgical exposure, avoids undue trauma to the ventricular myocardium, and offers an easy way for inspection of the left heart.

Adolescent↗
PubMed1982

Surgical treatment of patients with triple heart valve disease. Results and analysis of factors affecting the surgical outcome.

During a 10-year period (1972 to 1981), 48 patients underwent repair of combined aortic, mitral and tricuspid disease at our Institution. The aortic valve was replaced in 47 cases and treated by valvulotomy in one; the mitral valve was replaced in 47, and conservatively managed in one by means of open mitral commissurotomy; the tricuspid valve was treated by annuloplasty in 37, by commissurotomy in 3 and replaced in 8. Operative mortality decreased from 67% among those cases operated on normothermic cardiopulmonary bypass (CPB) with coronary artery perfusion (1972 to 1973) to 23% in those operated with mild hypothermic CPB and intermittent aortic cross-clamping (1974 to 1976), to 8% in patients treated with mild to deep hypothermic CPB and cold cardioplegic solutions (1977 to 1981) (p = 0.012). Analysis of the factors affecting the surgical risk has demonstrated that age at the time of operation, preoperative functional class, duration of the disease, preoperative cardiothoracic ratio and insertion of a prosthesis in the tricuspid position did not significantly influence the operative result. On the contrary, the recent techniques of myocardial protection with the use of cold cardioplegia, possibly associated with an earlier indication for operation and a prompter treatment of postoperative complications, were the major determinants of the improved surgical outcome.

Adult↗
PubMed1982

Evidence of impending embolization of a calcific cusp fragment from a mitral porcine xenograft.

The use of porcine bioprostheses has been associated with a low rate of embolic complications. The case here presented provides evidence that systemic emboli in porcine valve recipients may not necessarily be due to intracardiac or prosthetic thrombosis, but to detachment and migration of fragments of degenerated cusp tissue. Therefore, urgent assessment of xenograft function is recommended in patients with a porcine bioprosthesis who experience embolic episodes late postoperatively.

Bioprosthesis↗
PubMed1982

Postoperative pathology of congenital heart disease. I. Complete atrio-ventricular canal.

The postoperative pathology observed in 17 patients with complete atrioventricular canal, who died following total correction is described. In 3 patients, in whom valve replacement was necessary, the death was due to late prosthetic dysfunction. Out of 14 patients who underwent plastic repair, 4 died from undetected residual cardiac anomalies, which in 2 cases were associated with pulmonary obstructive vascular disease, 3 from unexplained myocardial infarction, 3 from inadequate postoperative care and 4 from pulmonary obstructive vascular disease which presented as an isolated finding. An analysis of the incidence of pulmonary obstructive vascular disease in these patients disclosed that it can develop before one year of age in some patients with Down syndrome.

Abnormalities, Multiple↗