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Biomedical subjects

A Renzulli

Publications and source records attributed to A Renzulli.

At least 37 records · Page 2Linked to original sources
PubMed2001

Surgery of rheumatic mitral stenosis: comparison of different techniques.

OBJECTIVE: The breakthrough of percutaneous transvenous mitral commissurotomy (PTMC) has dramatically changed the indications for the surgical treatment of rheumatic mitral stenosis over the last decade. No recent studies comparing long-term results of PTMC, open mitral commissurotomy (OMC) and mitral valve replacement (MVR) with bileaflet prostheses are available in medical literature. METHODS AND RESULTS: Between January 1991 and December 1997, 313 patients with pure and isolated rheumatic stenosis were treated in our department. One hundred and eleven patients underwent PTMC, 82 OMC and 120 MVR. There was no statistical difference (p>0.05) between the mortality rates of the three groups of patients. No cases of hospital mortality were observed in the patients who underwent PTMC and OMC, whereas two patients (1.6%) died within 30 days after MVR. Seven year actuarial survival results are: 95.41+/-2(SE)% (PTMC), 98.05+/-1% (OMC) and 92.82+/-33% (MVR) (p=NS). Freedom from embolism was 98.78+/-1% in PTMC, 98.78+/-1% in OMC and 92.52+/-2% in MVR (p>0.05); freedom from reoperation was 88.43+/-8% in PTMC, 96.35%+/-2% in OMC and 97.72+/-1% in MVR (p>0.05). The mean NYHA class at the end of follow-up was lower in OMC (1.14+/-0.3) versus PTMC (1.39+/-0.6) and MVR (1.41+/-0.71) (p=0.001). CONCLUSIONS: Even though conservative techniques are the first option to consider in treating mitral valve stenosis, valve replacement with bileaflet prostheses no longer represents a limiting factor to survival and quality of life.

Adult↗
PubMed2001

[Prevalence of vascular disease in candidates for myocardial revascularization with aortocoronary bypass: review of the literature and practical implications].

BACKGROUND: Cardiovascular disease remains the main cause of death and morbidity in the industrialized world. Atherosclerosis is a slowly progressive disease; coronary artery disease may be the first presentation of a systemic pathology. The association between coronary artery disease and peripheral vascular disease has often been confirmed by multicenter trials; nevertheless it still remains a subject of debate. METHODS: In order to assess the incidence of coronary artery disease and the degree of associated vascular lesions, between January 1997 and September 1999, in the Department of Cardiothoracic Surgery of the Second University of Naples (Italy), all candidates to coronary artery bypass grafting (CABG) were submitted to routine preoperative echo color Doppler study of the carotid vessels, abdominal aorta and iliac-femoral arteries. The correlation between the echo color Doppler findings, the angiographic patterns of coronary lesions and atherosclerotic risk factors was analyzed in all cases. RESULTS: Among 540 patients undergoing CABG, 418 (77.4%) had carotid disease, with a stenosis > 70% in 62 (11.3%). Forty-nine (79%) patients had asymptomatic severe carotid disease. A significant correlation between the severity of coronary disease and the incidence of severe carotid disease was found (p = 0.02). An abdominal aortic dilation was found in 37 cases (6.7%). Its diameter exceeded 35 mm in 14 patients (2.5%) and in 8 it was associated with triple vessel coronary disease. Atherosclerotic lesions of the iliac-femoro-popliteal axis were found in 394 (72.9%) patients and strongly correlated with the severity of coronary artery disease (p = 0.02); lesions were hemodynamically significant in 91 (16.8%) cases. CONCLUSIONS: Our study emphasizes the association between coronary artery disease and vascular disease. Non-invasive complete arterial investigation should be routinely performed in patients undergoing CABG.

Adult↗
PubMed2001

Standard 19mm St Jude aortic valves in patients with body surface less than 1.7m2.

Although new models of bileaflet valves with improved orifice have been devised, aortic valve replacement with 19mm prostheses still raises concerns about long term effects of residual transprosthetic gradient. We reviewed our experience with 19 mm standard model St Jude prostheses in 68 patients operated on between January 1983 and December 1995. Clinical late assessment was performed to evaluate the incidence of valve related complications. Postoperative echocardiography was performed to evaluate hemodynamic performance of the prostheses. Mean body surface area was 1.66+/-0.14 m2. Late postoperative peak gradient was 53.85+/-7.16 mmHg; mean gradient was 34.80+/-5.55 mmHg; effective orifice area was 1.93+/-0.05 cm2. Thirteen-year actuarial survival has been 90.89+/-0.6%; thirteen-year freedom from embolism 89.41+/-0.7% and freedom from hemorrhage 98.25+/-0.02%. No case of prosthetic endocarditis, thrombosis, or reoperation was observed during follow-up.

Aged↗
PubMed2001

Tricuspid repair for infective endocarditis: clinical and echocardiographic results.

We report our retrospective experience in the treatment of infective tricuspid endocarditis with valve repair From January 1981 through January 1999, 238 cases of infective endocarditis were seen at our institution, with tricuspid involvement in 19 cases. Tricuspid valve repair was performed in 9 patients whose valves had infective lesions involving a single leaflet. One goal of the repair was to avoid implanting any prosthetic material. At surgery, the posterior leaflet was completely excised and annuloplasty was performed in 4 patients. Wide quadrangular resection of the anterior leaflet and De Vega annuloplasty were performed in the other 5 patients. All patients had a good postoperative recovery Postoperative echocardiography showed no tricuspid regurgitation in 4 patients, mild regurgitation in 3, and moderate in 2. Follow-up ranged from 21 to 155 months (mean, 4756 +/- 50 [SD] months). Two late deaths occurred: one, 2 months postoperatively (sudden death), and the other, 108 months postoperatively (lung carcinoma). Late postoperative echocardiography showed no tricuspid regurgitation in 4 patients, mild in 2, and moderate in 2. No recurrent infection was observed. Tricuspid valve repair rather than valvulectomy or replacement is indicated in cases of right-sided endocarditis with single-leaflet involvement. Tricuspid repair enables eradication of the infection without implantation of prosthetic material.

Adult↗
PubMed2001

Long term clinical and echocardiographic results of isolated aortic valve replacement in elderly patients.

Results after isolated aortic valve replacement with bileaflet prostheses in patients over 70 years old were reviewed. One-hundred-twenty-eight elderly patients were operated on between January 1988 and January 2000. Patients with associated heart disease were excluded from the study. Preoperative data, early and late postoperative mortality, all valve related complications and data concerning anticoagulation status were recorded. Hospital mortality was 9.3%. Mean follow-up time was 60.98 +/- 2.23 months. Twelve-year actuarial survival was 69.6 +/- 0.08%. Valve related and anticoagulation related complication rates (0.8% and 1.6% respectively) and actuarial freedom (99 +/- 0.009 both) were low, as well as the mean interval between consecutive INR checks (18.39 +/- 1.90 days) and the mean INR value (2.17 +/- 0.135). Late echocardiographic results showed low postoperative mean transprosthetic gradients (15.48 +/- 0.94). Bileaftlet prostheses in the elderly can achieve excellent results with a low incidence of anticoagulation related complications and low risk of reoperation. Older age can no longer be considered a contraindication to bileaftlet prosthesis implant.

Age Factors↗
PubMed2000

Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant.

To evaluate the impact of early ischemic necrosis (IN) on the early and late outcome of heart transplantation, we reviewed our 11-year experience. Between January 1988 and June 1999, 207 heart transplants were performed in 205 patients (174 male and 31 female). Criteria for donor and recipient selection, and protocols for postoperative immunosuppression and rejection monitoring have remained unchanged over this period. Three different cardioplegic solutions were employed in graft preservation: St. Thomas Hospital solution in the earliest 31 cases (15%), University of Wisconsin solution in 96 cases (46.4%), and Celsior solution in the last 80 cases (38.6%). All patients who underwent at least one endomyocardial biopsy (176 patients) were divided into two groups according to the findings of IN within the early 3 postoperative months (group A, 49 patients with IN; group B, 127 patients without IN). The following variables were estimated in each group: donor and recipient age, ischemic time, type of cardioplegia, late mortality for cardiac causes, incidence of grade >2 rejection within the first 6 postoperative months, late incidence of grade >2 rejection, late incidence of NYHA class >II. No significant difference was found in any parameter between the two groups, except for the type of cardioplegic solution. A significantly higher incidence of ischemic necrosis in hearts preserved with St. Thomas solution was found (P < 0.001). Although pathology findings show that extracellular solutions carried a higher risk of early IN, no associated significant impairment in terms of late survival and event-free rate was observed in recipients with early IN.

Adolescent↗
PubMed2000

Are blood and valve cultures predictive for long-term outcome following surgery for infective endocarditis?

OBJECTIVE: To evaluate whether perioperative bacteria identification in blood and/or in valve cultures can predict early and late outcome of surgery for infective endocarditis, a retrospective study was performed. METHODS: Between January 1978 and December 1998, 232 patients, 79 (34.1%) female and 153 (65.9%) male with mean age of 44. 95+/-1.03 years (range 8-79) underwent surgery for infective endocarditis on a native (162 cases) or prosthetic (70 cases) valve. Patients were divided into three groups according to the perioperative x of microbiological tests: Group A: patients with preoperative positive blood cultures (83 cases); Group B: patients with positive valve cultures (35 cases); Group C: patients with negative blood and valve cultures (114 cases). Categorical values were compared by chi(2) analysis, whereas continuous data were compared by ANOVA and Bonferroni correction for post hoc comparisons. Analysis of late survival and complications was performed with Kaplan-Meier and Log Rank test. Late mortality, reoperation, perivalvular leak, recurrence of infection were considered as treatment failure. All data were presented as mean+/-standard error. RESULTS: Hospital mortality was 10.8% (9/83) in Group A, 8.6% (3/35) in Group B, and 14.9% (17/114) in Group C (P=0.52; not significant (NS)). Ten-year survival was 62.7+/-8% in Group A, 43.9+/-19% in Group B and 62.7+/-7% in Group C (P=0.38; NS). Ten-year freedom from reoperation was 85.2+/-6% in Group A, 37.9+/-20% in Group B and 80+/-6% in Group C (P=0.0034). Ten-year freedom from treatment failure was 56.3+/-8% in Group A, 31.6+/-16% in Group B and 55. 3+/-7% in Group C (P=0.46; NS). CONCLUSIONS: Positive blood and tissue cultures are not predictive for hospital mortality and late treatment failure in patients with infective endocarditis. Positive valve cultures, a common finding in patients with staphylococcal endocarditis, are predictive for a higher risk of reoperation.

Adolescent↗
PubMed2000

Long-term results of apico-aortic valved conduit for severe idiopathic hypertrophic subaortic stenosis.

We report our long-term results of apico-aortic conduit implantation in patients with isolated idiopathic hypertrophic subaortic stenosis. Between December 1977 and July 1983, apico-aortic prosthetic-valved conduits were implanted in 4 such patients (age range, 24-65 years) who had severe left ventricular hypertrophy and small left ventricular chambers. In this procedure, the distal end of the conduit was anastomosed to the ascending aorta in 3 patients and to the upper abdominal aorta in 1. Postoperative echocardiography showed relief of the left ventricle-aortic gradient and enlargement of the left ventricular chamber in all cases. One patient died of perioperative wound infection. One patient died of unnatural causes 13 years after the initial operation; in his case, the conduit was known to be occluded. Two patients are alive 15 and 19 years, respectively, after the initial operation. Three instances of conduit obstruction due to bioprosthetic calcification were observed. Despite the high incidence of reoperation due to conduit valve failure, apicoaortic conduit implantation has produced good hemodynamic outcome and has improved the quality of life in patients who have idiopathic hypertrophic subaortic stenosis and anatomic features unsuitable for Morrow's operation. Improvements in bioprostheses and in apical implantation techniques may allow a revival of apico-aortic conduit implantation in selected patients with idiopathic hypertrophic subaortic stenosis.

Adult↗
PubMed2000

Mitral and aortic valve endocarditis due to Staphylococcus lugdunensis.

Staphylococcus lugdunensis is a recently described coagulase negative staphylococcal species involved in human infections. Endocarditis caused by Staphylococcus lugdunensis has been reported rarely: fewer than 50 cases have been described so far. The infection is frequently complicated by embolic events and carries a high mortality rate. We report a case of endocarditis due to Staphylococcus lugdunensis in which the native mitral and aortic valves were infected. The bacterium was isolated on cultures from the aortic and mitral vegetations. Appropriate medical and surgical treatment led to a good outcome of the infection. At 6-year follow-up, there was no evidence of recurrence, and the patient showed good functional recovery. He was in New York Heart Association functional class I.

Aortic Valve↗
PubMed2000

Treatment of recurrent postoperative mediastinitis with granulated sugar.

BACKGROUND: The authors report their experience with granulated sugar as dressing technique in the treatment of postoperative mediastinitis refractory to a closed irrigation system. METHODS: Between January 1990 and January 1998, mediastinitis developed in 61 (0,93%) of 6521 patients who had undergone open heart surgery. Diagnosis of sternal infections was based on wound tenderness, drainage, cellulitis, fever associated with sternal instability. All of them were initially treated with surgical debridement and closed chest irrigation. Nine patients with postcardiotomy mediastinitis refractory to closed chest irrigation underwent open dressing with granulated sugar. All of them were febrile with leukocytosis and positive wound cultures. RESULTS: Bacteria isolated were staphylococcus aureus in 6 cases, staphylococcus epidermidis in 2 and pseudomonas in 1. Redebridement was performed in all cases and the wound was filled with granulated sugar four times a day. Fever ceased within 4.3+/-1.3 days from the beginning of treatment and WBC became normal after 6.6+/-1.6 days. Three patients had hyperbaric therapy as associated treatment. Complete wound healing was achieved in 58.8+/-32.9 days (three patients underwent successful pectoralis muscle flaps). CONCLUSIONS: Sugar treatment is a reasonable and effective option in patients with mediastinitis refractory to closed irrigation treatment. It may be used either as primary treatment or as a bridge to pectoralis muscle flaps.

Aged↗
PubMed1999

Intravascular hemolysis after mitral and aortic valve replacement with different types of mechanical prostheses.

Heart valve replacement with mechanical prosthesis is associated with mild intravascular hemolysis. In this study we evaluated the incidence of hemolysis in patients with different combinations of two mechanical valves. Between 1974 and 1996, 680 patients underwent mitral and aortic valve replacement with mechanical prostheses; we selected 90 patients, divided into six groups according to the prosthetic model (Group A, ball and tilting disc; Group B, ball and bileaflet; Group C, tilting disc and tilting disc; Group D, tilting disc and bileaflet; Group E, bileaflet and tilting disc; Group F, bileaflet and bileaflet; respectively, in mitral and aortic position). Blood tests were performed to check blood hemoglobin, serum lactic dehydrogenase, percent-correlated reticulocyte fraction, serum haptoglobin, and schistocytes. Chi square test was performed for categorical data. ANOVA and Bonferroni tests were performed in order to evaluate significant statistical differences between media and variance of the hematological data. A mild degree of intravascular hemolysis was observed in 30% of patients with double mechanical prostheses. LDH values were above the normal values in all groups, although a significant difference was found only between Group B versus Groups C and D. Reticulocytes and schistocytes and serum haptoglobin values were within the normal range and no differences were found between the groups. Low levels of blood hemoglobin were found in Groups D and F. The difference was statistically significant when compared with Groups A and E. In conclusion, hemolysis is frequent but never severe in patients with mitral and aortic mechanical prostheses. A higher incidence of subclinical hemolysis was found in patients with bileaflet valves regardless of the position of the implant.

Analysis of Variance↗
PubMed1999

Surgery for tricuspid valve endocarditis: a selective approach.

The authors report their 18-year experience in the surgical treatment of infective tricuspid endocarditis. Between January 1981 and January 1999, 238 cases of infective endocarditis were seen. with a tricuspid involvement in 21 cases (8.8%). Tricuspid valve repair was performed in 9 patients with infective lesions involving one single leaflet. The surgical principle of the repair was to avoid any prosthetic material implantation. Posterior leaflet vegetectomy was performed in another 2 patients with infected intracavitary leads. Tricuspid valve replacement was performed in 10 patients with involvement of the whole valvular apparatus. One patient died of septic shock 3 days postoperatively. All the other patients had a good postoperative recovery. Follow-up ranged between 12 and 155 months (mean 68.9 +/- 55 months). Five cases of late mortality were observed: 3 for cardiac reasons and 2 of cancer. All the other patients are alive. Late postoperative echocardiography in the patients with tricuspid repair showed tricuspid regurgitation to be absent in 6 patients, mild in 2, moderate in 1, and severe in 1. No recurrent infections were observed either in patients with valve repair or in those with valve replacement. Good early and long-term results can be achieved in the surgical treatment of tricuspid endocarditis as long as complete excision of the infected tissue is performed and risk factors are controlled.

Adult↗
PubMed1999

Late complications of heart transplantation: an 11-year experience.

Advances in donor and recipient selection and postoperative management of patients undergoing a heart transplant have improved survival after cardiac transplantation; nevertheless, late complications are still the main cause of mortality. Between January 1988 and March 1999, 200 heart transplants and 2 retransplants were performed at our Institution. The actuarial survival rate was 84.45% at 1 month, 75.22% at 1 year, and 69.48% at 5 years. One-hundred forty-five patients reached at least 6 months of follow-up. In this group of patients we reviewed all available pathological specimens from endomyocardial biopsies, autopsies, and hearts retrieved at retransplantation. The most frequent late complications have been: malignancies (9 patients), allograft coronary artery disease (ACAD) (6 patients), and infections (6 patients). All patients with ACAD had serological evidence of cytomegalovirus (CMV) infection and 5 of them (83.3%) of hepatitis C virus (HCV) infection. Squamous cell lung carcinoma and Kaposi's sarcoma were the most frequent neoplasms (3 patients). Twenty-six out of 145 patients died during the follow-up: sudden death occurred in 10 patients (38.46%), infections caused death in 6 patients (23.08%). ACAD in 4, and cancer in 4. Causes and rates of late mortality in patients with a cardiac transplant differ from those of early mortality. Development of infections, ACAD, or cancer is associated with a high late mortality rate. A striking correlation has been found between ACAD and HCV and/or CMV positivity. suggesting that such viruses may play a role in the development of vascular late complications in transplanted hearts.

Adolescent↗
PubMed1999

Percutaneous mitral commissurotomy versus open mitral commissurotomy: a comparative study.

OBJECTIVE: Although many studies in medical literature are comparing percutaneous trans-septal mitral commissurotomy (PTMC) and open mitral commissurotomy (OMC), very few long-term comparative follow-ups are available. METHODS: Between January 1991 and December 1997, 193 patients with isolated mitral stenosis were assigned either to PTMC (111 cases) or to OMC (82 cases). PTMC was performed in all cases with Inoue Ballon, OMC was performed with standard techniques. Categorical values were compared by chi square analysis, whereas continuous data were compared by Mann-Whitney test. Univariate survival and event free analysis (Kaplan-Meier+/-SE and log rank) were performed. Recurrent stenosis was classified any mitral valve area (MVA) less than 1.2 cm2 and whenever post-op. echo showed a loss more than 50% of the initial gain. Data were reported as mean+/-SD. Data concerning late echocardiographic assessment were studied with linear and logistic regression analysis. RESULTS: The two groups were homogenous as far preoperative variables as sex, mean age, MVA, echo score and incidence of left atrial thrombosis were concerned. Mean NYHA was preoperatively higher in OMC (2.79+/-0.58) versus PTMC (2.42+/-0.5) (P = 0.001). There was no hospital mortality in both groups. Incidence of hospital complications was similar (4/ 111 after PTMC and 1/82 after OMC; P = 0.3). Seven year survival: 95.41+/-0.02 (PTMC) and 98.05+/-0.01 (OMC) (P = 0.3) and freedom from late complications did not show statistical differences: Embolism 98.78+/-0.01 in PTMC and 98.78+0.01 in OMC (P = 0.8); Recurrent stenosis 71.89+/-0.13 in PTMC versus 82.89+/-0.08 in OMC (P = 0.2); Reoperation 88.43+/-0.08 in PTMC versus 96.25+/-0.02 in OMC (P = 0.4). A larger MVA was found in patients undergone to OMC (2.05+/-0.35) versus PTMC (1.81+/-0.33) (P = 0.001). Furthermore mean NYHA was lower in OMC (1.14+/-0.3) versus PTMC (1.39+/-0.7) (P = 0.001). CONCLUSIONS: Both techniques achieve with a low operative risk and low incidence of complications a good palliation of rheumatic mitral stenosis. Incidence of complications in the follow-up is similar. OMC allows a larger mitral valve area, a better functional recovery and a lower incidence of late mitral regurgitation.

Adolescent↗
PubMed1999

[Thrombosis of aortic valve prostheses: its incidence, morphological aspects and surgical treatment].

BACKGROUND: The authors report their experience on the diagnosis, pathological findings and surgical treatment of prosthetic aortic valve thrombosis. METHODS: Between January 1976 and June 1998, 1289 mechanical prostheses were implanted in aortic position at our institution: a prosthetic obstruction was found in 12 cases. Thrombolysis was performed in two cases and as a result, pathological findings were not available and the patients were excluded from the study. Ten patients underwent surgical treatment. RESULTS: Thrombectomy was performed in one case and prosthetic replacement was done in 9 patients. One patient died postoperatively of low-output syndrome, the others were discharged and no recurrence of thrombosis has been observed at follow-up. Primary thrombosis was found in 6 cases, and pannus formation was observed in 4 patients. All patients with primary thrombosis had a history of poor anticoagulation. Patients with pannus formation had a tilting disc prosthesis. CONCLUSIONS: Use of bileaflet prostheses and adequate anticoagulation can further lessen the incidence of this dreadful complication.

Adult↗
PubMed1999

Myocardial revascularization with arterial conduits. The use of lateral costal artery.

We describe the long-term results of a case of complete myocardial revascularization with arterial conduit employing also lateral costal artery (LCA). A fifty-four-year-old man underwent revascularization with the implant of right internal artery mammary (RIMA) on the second portion of the right coronary artery (RCA), of the left internal mammary (LIMA) on the left artery descendent (LAD) and of LCA on the obtuse marginal arteries. The postoperative course was uneventful and a twelve-month postoperative coronary angiography showed arterial conduits to be functioning well. LCA is another source for complete myocardial revascularization with arterial conduits.

Arteries↗
PubMed1997

Obstruction of mechanical mitral prostheses: analysis of pathologic findings.

BACKGROUND: The pathologic and echocardiographic findings observed in 87 patients with mitral valve obstruction were reviewed to ascertain the incidence of pannus formation versus that of thrombosis, the relationship between the two, and the time to the occurrence of pannus versus the time to thrombosis. METHODS: Pannus morphology (concentric or eccentric), its location on the valve (atrial, ventricular, atrioventricular), and the presence and relationship of associated thrombi (atrial, ventricular, atrioventricular) were analyzed. The times between valve replacement and the occurrence of obstruction were also compared. RESULTS: There were 10 caged-ball valves, 65 tilting-disc valves, and 12 bileaflet valves. Seventy-two patients underwent prosthetic replacement, and 15 underwent thrombolysis. Pannus alone was found in 27, pannus and thrombus in 39, and thrombus alone in 21. Primary thrombosis occurred earlier than pannus formation (p = 0.04); this was true for patients with bileaflet valves (p = 0.006) and those with tilting-disc valves (p = 0.04). Pannus was atrial in 19.7% (13/66), ventricular in 21.2% (14/66), and atrioventricular in 59.1% (39/66). Pannus morphology was concentric in 22.7% (15/66) and eccentric in 77.3% (51/66). Atrial secondary thrombi occur more often in patients with atrioventricular pannus (p = 0.04). Eight patients had reobstruction; this was caused by pannus formation in 5 and by thrombosis in 3. Five underwent reoperation, and 3 underwent thrombolysis. Reobstruction occurred earlier than the first event. CONCLUSIONS: The frequency of pannus formation is much higher than that of thrombus formation, but thrombosis is of earlier onset than pannus formation. Thrombosis is due to the deposition of clots on the prosthesis, and a pannus occurs as the result of an inflammatory reaction developing on both valve surfaces.

Adolescent↗