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Biomedical subjects

A Mazzucco

Publications and source records attributed to A Mazzucco.

At least 235 records · Page 13Linked to original sources
PubMed1982

Postoperative pathology of complete atrioventricular defects.

Necropsy data on 15 patients, who died after operations for complete atrioventricular defect (CAVD), were reviewed in order to analyze the possible determinants of death. Two infants had undergone a palliative procedure--pulmonary artery banding (Group I); three patients had had prosthetic replacement of one or both atrioventricular (AV) valves (Groups II); and the remaining 10 had had conservative repair with plastic reconstruction of the AV valves (Group III). The most notable pathological findings related to death were as follows: Group I, left ventricular hypoplasia in both infants; Group II, prosthetic dysfunction in all patients; Group III, extracardiac diseases in two-patients and cardiac lesions in six. In Group III severe pulmonary vascular obstructive disease (PVOD) was observed as an isolated finding in two patients and in combination with residual intracardiac anomalies in another two. Analysis of the incidence of PVOD demonstrated that irreversible changes may occur within the first year of life in babies with Down's syndrome, and that these changes well correlate with the calculated pulmonary vascular resistance (PVR) values. From the results of this study we have reached the following conclusions: (1) Prosthetic valve replacement has to be avoided because of a high incidence of prosthesis-related complications and the effectiveness of conservative repair; (2) residual untreated anomalies may affect the outcome of operation and should be accurately recognized and weighted preoperatively; (3) PVOD can occur in CAVD even before the first year of life and can be reliably assessed by the measurement of PVR. High degrees of PVOD frequently interfere with the surgical success, particularly when residual intracardiac anomalies are present. Therefore, we suggest that surgical correction be planned, when indicated, during the first 6 months of life.

Adolescent↗
PubMed1982

Pregnancy in a patient after mitral valve replacement with a porcine bioprosthesis.

The course of two pregnancies in a woman, who had previously undergone mitral valve replacement with a porcine bioprosthesis, is reported. The present case suggests that porcine heterografts are to be considered as the most suitable cardiac valve substitutes in females of childbearing age, since anticoagulants are not needed, avoiding therefore the risks related to both an incorrect anticoagulation and to the recognized teratogenic effect of coumarin drugs.

Adult↗
PubMed1981

Delayed cardiac tamponade following open heart surgery. Analysis of 12 patients.

The present report reviews our experience with 12 cases of delayed cardiac tamponade following open heart surgery, which occurred at various times after the seventh postoperative day (average 19 days). In each case the diagnosis was made on clinical grounds, supported by the radiographic findings in all, and confirmed by echocardiography in 4. Pericardial effusion was serous in 5 patients, sero-sanguineous in 3, sanguineous in 3, and purulent in one; it was most frequently caused by a postpericardiotomy syndrome (7 cases). A single pericardiocentesis was curative in 6 instances, while repeat procedures were required in 2 because of recurrence. A repeat median sternotomy was performed in 5 patients associated with pericardiocentesis, and a pericardiectomy in 2. Three patients died within one month from the initial operation; no recurrences have been noted so far in the long-term survivors. According to the results of the present investigation, early clinical recognition is considered the clue to a successful outcome. Sole pericardiocentesis is followed by immediate improvement of the patient's state, and is often curative, but recurrences may require other maneuvers for further fluid evacuation. Awareness of this possible complication may contribute to a decrease in the still high mortality rate associated with this condition.

Adolescent↗
PubMed1981

Aortic valve replacement in active infective endocarditis.

From 1970 to 1979, 23 patients underwent isolated aortic valve replacement because of active infective endocarditis at our Institution. The main indications for open heart surgery were cardiac failure unresponsive to medical treatment, embolic episodes and septic status. Staphylococci and streptococci were the most frequent offending microorganisms, which could be identified either from blood or valve cultures in 65.2% of the cases. Operative and late mortality was low (4.3 and 4.5% respectively), and postoperative complications rare. The favorable results, probably related to early surgical treatment, and the low incidence of postoperative complication seem to warrant an aggressive approach in the active phases of infective endocarditis involving the aortic valve.

Adult↗
PubMed1981

[Surgical treatment of infectious endocarditis in the active phase. Experience in 40 cases].

Despite recent advances in antimicrobial therapy infective endocarditis (IE) still remains a major surgical problem. All patients undergoing surgical treatment for IE at our Institution since 1970 were reviewed; among these in 40 IE was considered to be active at time of operation. Thirty patients were males and 10 females, ranging in age from 11 to 66 years (average 41); indications for operation were heart failure in 31, mycotic emboli in 5, and sepsis in 4. Nine were in NYHA functional class 11, 18 in NYHA class III, and 13 in class IV. Aortic valve replacement (AVR) was performed in 24 cases, mitral valve replacement (MVR) in 5 and multiple valve replacement (PVR) in 11. Overall hospital mortality was 15% (4.2% in the AVR group, 40% in the MVR group, and 27% in the PVR group). Postoperative follow-up was available in all survivors. Four patients died in the late postoperative period for not infective causes. Almost long-term survivors show, from 7 months to 10 years (average 58 months) postoperatively, a significant improvement. No complications related to the initial infective process were recorded. According to the results of the present study the following conclusions can be drawn: 1) active IE does not represent a contraindication to open heart surgery and prosthetic valve replacement; 2) the surgical results depend not only on the degree of cardiac failure, but mainly on its duration; 3) early surgical intervention affects favourably the prognosis, especially in cases of isolated aortic valve involvement; 4) the surgical management of IE removes the focus of infection.

Adolescent↗
PubMed1980

Double-chambered right ventricle: surgical experience and anatomical considerations.

Fourteen patients with double-chambered right ventricle underwent surgical treatment and repair of associated anomalies. The anomalous muscle band was isolated in 5 cases, associated with membranous ventricular septal defect in 7, with discrete sub-aortic stenosis in one and with double outlet right ventricle in one. All patients survived. The obstructing muscular band was a hypertrophic structure identifiable either with a displaced moderator band, still related to the anterior papillary muscle, or with a giant septoparietal band, inserting to the anterior free wall and occasionally present in normal hearts. According to this interpretation, referring the obstructive band to the septomarginal complex, double-chambered right ventricle should not be regarded strictly as a truncoconal malformation.

Adolescent↗
PubMed1980

Left ventricular rupture following mitral valve replacement with a Hancock bioprosthesis.

A rare complication of mitral valve replacement with the Hancock bioprosthesis was observed in three patients presenting with prevalent mitral stenosis and normally-sized left ventricular cavity. In the patients, a deep erosion of the left ventricular free wall was present which evolved into cardiac rupture in one of them. The laceration is ascribed to the friction between a prosthetic strut and the myocardium; a disproportion between the "high-profile" device and the left ventricular chamber is suggested to explain this complication, which may be avoided by employing a "low-profile" prosthesis.

Bioprosthesis↗
PubMed1980

Tricuspid atresia with double-outlet left atrium.

Clinical and pathologic findings of an unusual case of cardiac malformation are presented. The main features were those of atresia of the right atrioventricular valve associated with two distinct atrioventricular orifices connecting the morphologically left atrium to the underlying morphologically left ventricle. Other distinguishing characteristics were ostium secundum atrial septal defect, normally related great arteries, with the aorta arising from the main ventricular chamber and the pulmonary artery from the anterior and right-sided outlet chamber, and infundibular and valvular pulmonary atresia.

Abnormalities, Multiple↗
PubMed1980

[Structural changes of Hancock bioprostheses in children (author's transl)].

Conservative management is the treatment of choice for either congenital or acquired valvular disease in children. However, prosthetic valve replacement may sometimes be required and in this situation the surgeon is faced with the problem of which valvular substitute is the best for this particular patient. The glutaraldehyde-preserved Hancock porcine xenograft has been considered the safest one to use in the pediatric age group since the risks of thromboembolism as well as the mortality and morbidity related to anticoagulant treatment are reduced with this device. However durability of porcine bioprostheses at this time is still unknown, and it remains one of its major concerns. Recent reports have highlighted that porcine heterografts implanted in children undergo early and severe fibrocalcific degeneration. After having reviewed our pathological collection of explanted Hancock valves we have summarized our experience with pathology of porcine bioprostheses in young patients in the present report. Five Hancock heterografts were available for gross and histologic examination. They came from 3 children, 2 females and 1 male, who died or were reoperated upon because of prosthetic dysfunction. Both girls, aged 8 and 10 years, had undergone total correction of complete a-v canal which required mitral valve replacement in the first and mitrotricuspid valve replacement in the second. The first one was reoperated 2.10 years after surgery because of severe prosthetic stenosis and died in the 1st postoperative day of low output syndrome. The second, who developed the signs of mitral stenosis 3.4 years later, was successfully reoperated, but died in severe heart failure 2.9 years following mitral prosthetic re-replacement. The third patient, a 11-year-old boy, underwent mitral valve replacement because of mitral incompetence due to bacterial endocarditis; 5.4 years after surgery he necessitated reoperation because of mitral prosthetic stenosis. He is currently asymptomatic. Pathologic examination of the 5 explants (4 mitral, 1 tricuspid) which had been in place from 34 to 72 months (average 49 mos), showed a severe stenosis with impairment of the effective prosthetic orifice in all. The stenosis was due to coarse calcific deposits of the cusps and commissures and was worsened in 3 cases by fibrous tissue overgrowth on the inflow aspect of the leaflets. In 2 cases an atrial thrombosis was observed, as a consequence of prosthetic stenosis. Histologic examination together with microradiographic investigation showed in all cases the presence of diffuse calcifications of commissures and leaflets. Our pathological experience confirms that the Hancock bioprostheses, when implanted in children, undergoes structural changes early and severe enough so as to discourage their employment in this group of patients.

Bioprosthesis↗
PubMed1975

[Postoperative bacterial endocarditis after cardiac prosthesis (author's transl)].

The infection of an endocardial prosthesis, either valvular or septal patch, is a frequent and dangerous post-operative complication. Eleven patients having postoperative endocarditis (9 on valve prosthesis and 2 on ventricular septal patch) are the subject of this paper. Six of the 7 infected "early" had Gram-negative bacteria in the blood cultures, while staphylococus aureus, streptococcus viridans and klebsiella pneumoniae were responsible for 3 of the 4 "late" infections. In 2 patients, one "early" and one "late" the causative bacteria were not identified. The definite prevalence of Gram-negative flora in post-operative endocarditis may have been facilitated by the routine use of antibiotics after open-heart surgery. Three of the 11 patients survived, one after replacement of the infected prosthesis and two after prolonged specific antibiotic treatment. On the basic of this experience, compared with other written reports, the authors propose to treat postoperative endocarditis medically for approximately 5 weeks, with full doses of specific antibiotics, reserving for surgical treatment only the cases of prosthetic malfunction, left atrial thrombosis, peripheral embolization and in those patients where the medical treatment fails.

Adolescent↗