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Biomedical subjects

A Mazzucco

Publications and source records attributed to A Mazzucco.

At least 91 records · Page 5Linked to original sources
PubMed1995

Bicuspid homograft reconstruction of the right ventricular outflow tract in infants.

BACKGROUND: The use of homograft tissue in cardiac surgery has progressively increased so that supply is limited, especially in the sizes required for neonatal and infant cardiac operations. METHODS: We developed in recent years a technique for surgically reducing the size of more readily available large-diameter homografts, making them suitable for right ventricular outflow tract reconstruction in small infants. This is achieved by means of a longitudinal incision of the oversized conduit, excision of one homograft cusp, and oversewing of the "bicuspid" homograft wrapped around a dilator of appropriate size. Five patients (2 male, 3 female) ranging in age from 20 days to 11 months (mean age, 8.3 months) and ranging in weight from 3.2 to 7.4 kg (mean 6.2 kg) underwent reconstruction of the right ventricular outflow tract using this surgical technique (tetralogy of Fallot/pulmonary atresia, 3 cases; truncus arteriosus, 1 case; double-outlet right ventricle, 1 case). RESULTS: There were no operative deaths and no instances of valve-related complications at a mean follow-up of 19 months. Serial echocardiography shows mild homograft stenosis in 1 patient (15 mm Hg) and mild homograft insufficiency in 1 patient. CONCLUSIONS: Although a longer follow-up is certainly required to determine whether the surgically modified bicuspid homografts will be as durable as the intact ones when positioned in the right ventricular outflow tract, we believe that this technique may represent a valuable therapeutic alternative, at least in the short term, to the use of synthetic grafts when an appropriately sized homograft is not available.

Blood Vessel Prosthesis↗
PubMed1995

Stentless porcine bioprostheses in the treatment of aortic valve infective endocarditis.

Between January 1992 and June 1994, 23 patients underwent surgery for aortic valve endocarditis at the Department of Cardiovascular Surgery of the University of Verona; a subgroup of 10 patients underwent aortic valve replacement with a porcine stentless valve (Biocor LTDA n = 8; Toronto SPV n = 2). There were 7 males and 3 females with a mean age of 56.3 years (range, 36 to 73 years). Eight patients had active endocarditis and two had healed endocarditis. Nine patients had native valve in endocarditis, the presence of a bicuspid aortic valve in 2, and 1 patient had recurrent prosthetic valve endocarditis (PVE), 7 of whom were in New York Heart Association (NYHA) Functional Class IV. The main indications for operation were congestive cardiac failure, active sepsis, and presence of large and mobile vegetations by echo and arrhythmias. There were no operative or late mortalities in this subgroup of patients. Short-term survival is 100% at a mean follow-up time of 11.2 months (range, 4 to 18 months), with no recurrent endocarditis or valve-related complications.

Adult↗
PubMed1995

Bacillus licheniformis prosthetic aortic valve endocarditis.

A 73-year old man developed an acute prosthetic aortic valve dehiscence for which emergent operation was undertaken. The intraoperative evidence of an aortic annular disruption and of a subannular abscess led to the hypothesis that an endocarditis process was involved. The aortic valve was replaced with a stentless porcine bioprosthesis. Cultures taken intraoperatively from the aortic area had a pure growth of aerobic, spore-forming, gram-positive bacilli identified as Bacillus licheniformis. The patient responded to specific antibiotic therapy with no relapse at a 20-month follow-up. The potentiality of B. licheniformis as a pathogen should be reconsidered.

Aged↗
PubMed1995

Preliminary experience with pulmonary autografts.

Between July 1994 and March 1995, seven patients (six male) with a mean age of 27 years (range 18 to 34 years) were selected for aortic valve replacement with a pulmonary autograft (Ross operation). The aortic valve disease was isolated insufficiency in four cases, stenosis in one and mixed lesion in two. Three patients had a bicuspid aortic valve. Previous cardiac surgical procedures had been performed in two cases (coarctation repair and valvuloplasty in one; isolated aortic valvuloplasty in one). Two patients were in NYHA class II and five in class III. In two cases the autograft was inserted as a scalloped subcoronary implant. Four patients had total aortic root replacement with re-implantation of the coronary ostia. The RVOT was reconstructed with a cryopreserved homograft (five pulmonary two aortic). The aortic cross-clamp time was 150 +/- 10 minutes with a total bypass time of 212 +/- 14 minutes. There was neither operative nor late mortality. Postoperative echocardiography revealed trivial autograft insufficiency in one case with a mean transvalvular gradient of 15.8 mmHg. All patients improved symptomatically (100% in NYHA class I). Freedom from reoperation, valve related complications and endocarditis is 100% at a mean follow up of 5.6 months (range 1-9 months). This preliminary experience supports the concept of pulmonary autograft implantation in selected patients.

Adolescent↗
PubMed1995

Successful repair of complete sternal cleft associated with congenital heart disease. Report of one case.

Total failure of sternal fusion without other developmental anomalies of the chest and abdominal wall is rare. We report on a 52-year-old man with a total cleft sternum associated exclusively with an ostium secundum type atrial septal defect, a large cono-ventricular septal defect and pulmonary stenosis, who underwent successful surgical repair of the congenital heart disease and of the sternal anomaly by direct approximation of the freshened sternal remnants to the midline without interposition of tissue graft or inert prosthesis. This technique should be considered and attempted first as a better surgical option even in adult patients.

Abnormalities, Multiple↗
PubMed1995

Use of oversized homografts for right ventricular outflow tract reconstruction in infants.

A surgical technique for reducing the size of large diameter homografts in order to make them suitable for right ventricular outflow reconstruction in infants was clinically introduced by us at the Department of Cardiac Surgery, University of Padova in 1990. The method consists of two longitudinal incisions along the oversized homograft root removing one cusp with the relevant part of the aortic annulus and aortic wall. The remaining, flat "bicuspid" homograft is closed into a tube again around a mandrel of appropriate size. Preliminary experiences with the first three patients were excellent and have already been reported. The current study includes five additional patients (two male, three female) ranging in age from 20 days to 11 months (mean 8.3 months) and in weight from 3.2 to 7.4 kg (mean 6.2 kg) who underwent right ventricular outflow tract reconstruction with this surgical technique. There were no operative deaths and no instances of valve related complications at a mean follow up of 18 months. Serial echocardiography showed mild homograft stenosis in one patient (15 mmHg) and mild regurgitation in another. Although a longer follow up is necessary to determine whether the durability of these surgically modified "bicuspid homografts" can match that of the intact valves, we believe that our technique represents a valuable therapeutic alternative at least in the short term to the use of synthetic grafts in infants when an appropriately small homograft is not available.

Bioprosthesis↗
PubMed1994

Replacement of the descending thoracic aorta for massive aneurysm in neonatal Marfan syndrome.

We describe a patient with neonatal Marfan syndrome presenting with massive ascending and descending thoracic aortic aneurysm. Because of rapidly progressive respiratory distress due to tracheobronchial compression, emergency replacement of the descending thoracic aorta with a 12-mm PTFE vascular prosthesis was undertaken at 1 month of age. The postoperative course was complicated by bilateral tension pneumothorax contributing to irreversible respiratory failure. The unique clinico-pathological features and the relevant surgical implications of the case are discussed.

Angiography, Digital Subtraction↗
PubMed1994

Cardiac myxoma of the tricuspid valve: description of a case and review of the literature.

Although myxomas are the most common cardiac neoplasms in the adult population, they are very rare in pediatric patients. Tricuspid valve myxomas are even more exceptional at all ages, with only 16 cases being reported in the literature. We describe the case of a 10-year-old boy with a myxoma of the tricuspid valve, who was successfully operated without valve replacement.

Child↗
PubMed1994

[Isolated left ventricular myxoma discovered by two-dimensional echocardiography].

We describe the case of a young patient in whom two-dimensional echocardiography, performed because of mild palpitation, discovered the presence of a small mass into the left ventricle, attached to the interventricular septum. The patient was operated upon on cardiopulmonary by-pass, and the mass was removed through the aortic valve, without any complication during the postoperative period. On histology the mass appeared to be a typical myxoma. This case has been reported because the infrequency of ventricular location of the myxoma is unusual, and because the use of 2D-echocardiography, even in the absence of significant symptoms and/or clinical signs, avoided dangerous embolic complications, which often represent the first sign of this neoplastic pathology.

Adult↗
PubMed1993

Clinical results of steroid-free induction immunosuppression after heart transplantation.

Between January 1987 and September 1991, 112 operative survivors of heart transplantation were initially immunosuppressed with cyclosporin A and azathioprine without prednisone. Eighty-eight patients (79%) remained on a regimen of double therapy for a mean follow-up of 25 +/- 15 months (range, 1 to 54 months), whereas 24 patients (21%) had oral prednisone, 5 mg/day, added to maintenance therapy for persistent or repeated rejection. There were 5 early deaths (4%) because of acute rejection (4 patients) or infection (1 patient). Only 1 patient died late after heart transplantation of chronic rejection. Actuarial survival was 95% +/- 2% and 94% +/- 3% at 12 and 48 months, respectively. Mean rate of acute rejection was 1.7 +/- 1.0 episodes per patient, with a 5% +/- 2% freedom from rejection at 48 months. Ten patients (9%) required in-hospital treatment for infection; the actuarial freedom from infectious episodes was 85% +/- 4% at 48 months. Actuarial freedom from hypertension was 43% +/- 7% at 48 months. At annual catheterization, mean left ventricular ejection fraction was 0.64 +/- 0.08 and 0.62 +/- 0.05 at 1 year and 4 years, respectively, with evidence of coronary lesions in 9 patients (8%). In conclusion, steroid-free immunosuppression after heart transplantation is associated with a high incidence of acute rejection. However, the excellent medium-term survival and the low incidence of both infection and chronic rejection seem to justify a wider use of such treatment.

Adolescent↗