Search PubMed⌕ Search

Biomedical subjects

A Renzulli

Publications and source records attributed to A Renzulli.

At least 55 records · Page 3Linked to original sources
PubMed1997

Long-term follow-up of open commissurotomy versus bileaflet valve replacement for rheumatic mitral stenosis.

OBJECTIVE: Despite the achievements of third generation mechanical cardiac valve prostheses, conservative procedures are still considered the best surgical option for rheumatic mitral valve stenosis. To compare long-term results of open mitral commissurotomy (Group A) and mitral valve replacement with bileaflet prostheses (Group B) a 15-year follow-up study was carried out. METHODS: From January 1981 to May 1996, 540 consecutive patients with pure isolated rheumatic mitral stenosis underwent mitral valve surgery: 300 had mitral commissurotomy and 240 valve replacement. The follow-up was 99.05% complete and ranged between 1 and 185 months in Group A and from 1 to 171 months in Group B. RESULTS: Hospital mortality was 2% in Group A and 2.08% in Group B. Late mortality was 1% in Group A and 3% in Group B. The 10-year survival rates were 98.7% +/- 1% in Group A and 93.7% +/- 3% in Group B. There was a statistically significant difference of freedom from reoperation in Group B (97.7% +/- 1%) versus Group A (88.1% +/- 2%) (P = 0.04). In group A 14 embolic events occurred (93.7% +/- 2%), and 15 (6.52%) in Group B (83.9% +/- 7%). Haemorrhagic events were observed in 2 patients (0.68%) of Group A (99.3% +/- 0.5%) and in 3 patients (1.3%) of Group B (98.4% +/- 1%). CONCLUSIONS: Long term results of mitral commissurotomy were more satisfactory than those obtained with bileaflet valves. Reoperation rate was higher in mitral commissurotomy.

Adolescent↗
PubMed1997

Thrombolysis for prosthetic valve thrombosis: indications and results.

BACKGROUND AND AIMS OF THE STUDY: Prosthetic valve obstruction is caused by thrombi or fibrous tissue overgrowth, or both; thrombolysis avoids reoperation-related risks, but is effective only on clots. Hence, the study aims were to: (i) further assess our indication criteria for thrombolysis in prosthetic valve thrombosis; and (ii) evaluate treatment and follow up in a large patient population. METHODS: Between January 1991 and January 1994, 20 cases of prosthetic thrombosis were treated with thrombolysis using recombinant tissue type plasminogen activator (rt-PA). Indication criteria for thrombolysis were: (i) recent onset of symptoms; (ii) transesophageal echocardiographic (TEE) evidence of clots on the valve or cardiac chambers; and (iii) a partially preserved disc excursion. All patients were fitted with mechanical valves (four caged balls, 10 tilting discs, six bileaflets), with 17 valves located in the mitral and three in the aortic position. Symptoms of obstruction comprised cardiac failure in 11 cases and/or embolism in 10. RESULTS: After rt-PA infusion, normal prosthetic function was restored in all patients, though one underwent successful reoperation five days later. During infusion, five patients had a transient ischemic attack and one a minor transient peripheral embolism. Recurrence of thrombosis occurred in three patients during follow up; subsequent thrombolysis was successful in two, without complication. CONCLUSIONS: As treatment proved satisfactory, the reliability of our indicational criteria was confirmed. Only transient complications arose during treatment with recurrent thrombosis most common in those patients who had more thrombogenic valve prostheses.

Adult↗
PubMed1997

Long-term results of heart valve replacement with bileaflet prostheses.

Bileaflet cardiac prostheses (St. Jude, CarboMedics, Duromedics, Bicarbon, Jyros) have shown a low incidence of complications and good haemodynamic performance. In the last twelve years, 783 bileaflet prostheses were implanted in 690 patients at our Institution. The population of our study comprises 591 bileaflet prostheses (418 CarboMedics, 124 St. Jude, 49 Bicarbon) implanted in the mitral (MVR) (n = 305) or aortic (AVR), (n = 286) position. The follow-up study evaluated 292 male and 295 female patients with age ranging from 13 and 79 years (mean 50.4 +/- 14.7 years). Hospital mortality was 6.6%. Follow-up was 97% complete, with 1822 +/- 33 patient/years and a mean follow-up of 37 months (range 1 to 144 months). Twelve years actuarial freedom from complication according to prosthetic site were calculated as follows (linearized rates in parentheses): late mortality AVR 97.6% +/- 0.6% (2.3%), MVR 96% +/- 0.5% (2.1%); thrombosis AVR 100%, MVR 96% +/- 0.9% (0.8%); embolism AVR 97% +/- 0.5% (1.5%), MVR 96.6% +/- 0.7% (1.8%). Global freedom from anticoagulant-related haemorrhage was 95% +/- 1.2% (2.3%) and 94.5% +/- 0.7% (2.2%) following AVR, 94 +/- 0.6% (2.1%) following MVR. The difference of the haemorrhagic risk for prosthetic site was not significant (p > 0.05). Functional improvement was confirmed by the low postoperative NYHA functional class. According to our results, cumulative experience with bileaflet valves has shown very good long-term results in term of low rate of complication, long-term survival and quality of life.

Actuarial Analysis↗
PubMed1996

Submitral left ventricular aneurysm. Report of 2 surgical cases.

Submitral left ventricular aneurysm most commonly occurs among the black population. Nevertheless, this lesion has been described among whites. We report 2 cases of submitral left ventricular aneurysm that we treated successfully by surgery. Case 1 is that of a 52-year-old Brazilian black man with a submitral left aneurysm and mitral incompetence. Case 2 is that of a 25-year-old white man with a history of recurrent stroke; his echocardiographic study showed a small submitral left ventricular aneurysm. Due to the growing incidence of submitral left ventricular aneurysm among the white population, we emphasize the importance of a targeted echocardiographic study in all patients with a history of embolic episodes in the absence of apparent risk factors for embolism.

Adult↗
PubMed1995

Mechanical valve replacement under 12 years of age: 15 years of experience.

Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Growth of the child and adequate anticoagulation level are the main concerns when valve replacement is performed in the pediatric age. We reviewed the case histories of 29 children who underwent valve replacement with mechanical prosthesis from 1979 to 1994 in order to evaluate the performance of mechanical valves in this age group. Age ranged from two years to 12 years (mean 8.97 +/- 3.7 years). A total of 31 valves were implanted; 17 children had atrioventricular (Av) valve replacement (15 mitral, one common Av (heterotaxia), one tricuspid (systemic ventricle)), 11 children had aortic valve replacement (one redo), and one child had double mitral and aortic valves implanted. The etiology of valvular disease was congenital in 34.5%, degenerative in 17.2%, rheumatic in 24%, infective in 13.8%, and prosthetic dysfunction in 10.3%. Of the 29 patients, eight had undergone previous procedures and eight required simultaneous repair of associated lesions. There were three hospital deaths (10.3%). The mean follow up was 5.79 +/- 5.36 years. There were four late deaths (2.66%/patient-year) at a mean of 37 months from surgery. All operative survivors received oral anticoagulation with sodium warfarin. No thromboembolic event or bleeding occurred, no endocarditis developed in any patient; one reoperation was performed for patient/prosthesis mismatch. Mechanical valves offer excellent hemodynamic performances and a low rate of thromboembolism and/or bleeding in our experience, and are our first choice for heart valve replacement in children when reparative surgery is not feasible.

Aortic Valve↗
PubMed1995

Stentless fresh pulmonary homograft in mitral position.

We report the implantation of a fresh, stentless pulmonary homograft in the mitral position as an attempt to treat the 2nd recurrence of prosthetic endocarditis in a 66-year-old man. The postoperative course was uneventful; early postoperative transesophageal echocardiography showed a competent valve with a gradient of 4.2 mmHg. Fifteen months postoperatively, transthoracic echocardiography showed a good functioning homograft with a competent valve and no recurrence of endocarditis.

Aged↗
PubMed1994

Prosthetic valve obstruction: thrombolysis versus operation.

An acute obstruction is a life-threatening complication of mechanical valve prostheses, and is caused by the formation of fresh clot or fibrous tissue overgrowth, or both. Accurate selection of the most appropriate treatment for a particular patient is mandatory. From January 1991 to July 1992, 28 cases of prosthetic thrombosis were managed. Twenty patients underwent surgical treatment, with one operative death, and 8 patients were treated with thrombolysis using recombinant tissue-type plasminogen activator (rt-PA). The criteria for using thrombolysis were (1) the recent onset of symptoms, (2) transesophageal echocardiographic evidence of clots on the valve or cardiac chambers, and (3) preserved disc excursions. All patients who underwent thrombolysis had mechanical valves (two bileaflets, four tilting discs, and two ball valves); seven valves were in the mitral position and one was in the aortic. Symptoms of obstruction consisted of cardiac failure in 6 cases or thromboembolism in 5, or both. The mean interval between the onset of symptoms and the initiation of thrombolysis was 81 +/- 65 hours. After infusion of the rt-PA, normal valve function was restored in all patients, as documented by transesophageal echocardiography. No deaths or neurologic complications occurred; there was one episode of minor peripheral embolism. Thrombolysis using rt-PA may be the appropriate treatment in patients with primary thrombosis of mechanical valves, thereby avoiding the operation-related risks.

Adult↗
PubMed1994

[Infective endocarditis today; heart surgery in its treatment: how and when].

The authors report the experience of 161 surgical cases operated between 1980 and 1992 because of valve endocarditis. Two hundred and two surgical procedures were performed. Patients were divided into two groups: Group I (EN) considered 117 patients with endocarditis on the native valve; Group II (EP) included 64 patients with prosthetic endocarditis. In 23 patients the prosthesis was implanted for previous endocarditis on the native valve (EP1); in 41 patients the prosthesis was implanted for other valve diseases (EP2). Each group was described according to sex, age, site of endocarditis, previous cardiac diseases, socio-economical level, hemodynamic and infective conditions at surgery, etiology of endocarditis, surgical indication, pathology report, surgical procedure and results. The results were evaluated considering surgical mortality, late mortality and recurrence of endocarditis. The main risk factors were correlated to overall survival and recurrency. Hospital mortality was 7.6% in EN, 13% in EP1, 36.5% in EP2; endocarditis recurrency was 20.3% in EN, 65% in EP1, 19.2% in EP2. Sixteen patients with prosthetic endocarditis were submitted to a second reoperation with 50% mortality; 4 patients to a third reoperation with 50% mortality; 1 patient to a fourth reoperation with no mortality. Actuarial overall survival was 40.3% at 12 years in Group EN, 33.3% at 12 years in Group EP1, 73.4% at 12 years in Group EP2. Finally the Authors report the experience of 12 stentless grafts (autologous, homologous and eterologous) implanted between March 1991 and July 1994 in patients with valve or prosthetic endocarditis with no recurrency at 42 months of follow-up.

Actuarial Analysis↗
PubMed1994

[Surgical treatment of incessant atrial tachycardia: description of a case].

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.

Electrocardiography↗
PubMed1994

Early experience with the Jyros bileaflet valve in the mitral position: high incidence of valve thrombosis.

The Jyros valve is a new bileaflet valve with the unusual feature that the hinge is expected to rotate continuously inside the housing. Nine isolated Jyros mitral prostheses were implanted from July to October 1993. All patients survived the surgical procedure and during the follow up underwent transthoracic (TTE) and transesophageal echocardiograms (TEE) for the evaluation of hinge rotation. Neither TTE nor TEE were able to show hinge rotation in any patient at any time. Five patients had prosthetic thrombosis. In the successfully treated with thrombolysis. In the remaining patient thrombolysis was contraindicated. Eight patients are alive; one died of gastro-intestinal bleeding a few months after discharge. The absence of hinge rotation may be the triggering mechanism of valve thrombosis although no explanted prostheses were available for examination. Further studies are necessary to understand the mechanism of valve thrombosis with the Jyros bileaflet prosthesis.

Adult↗
PubMed1994

Acute postoperative block of mechanical prostheses: incidence and treatment.

Acute intermittent postoperative block of mechanical prostheses is a rare and life-threatening complication; its incidence and treatment are not well defined. Between January 1975 and June 1991, 2839 mechanical prostheses were implanted using the same technique: mattress suture for mitral valve replacement and simple suture for aortic valve replacement. Prosthetic block occurred in eight patients: four following mitral valve replacement and four after aortic valve replacement. The blocked prosthesis was always a tilting disc valve (five Sorin, two Björk-Shiley and one Medtronic). The event occurred over a time interval of 6-48 h (mean(s.d.) 17.3 (15.6)h). All patients having mitral valve replacement needed emergency prosthetic replacement. In aortic valve replacement, reoperation was necessary in two patients; the disc block disappeared in the others. All patients are alive with a follow-up ranging between 3 and 168 (mean 32.5) months. No structural failure was found in explanted prostheses leading to a diagnosis of extrinsic block. The overall incidence of this complication was 0.28% (eight of 2839); 0.24% (four of 1645) for mitral valve replacement and 0.33% (four of 1194) for aortic valve replacement respectively (n.s.). It was exclusively related to tilting disc valves (0.44%; eight of 1830) versus ball and bileaflets valve (0 of 1009). In mitral valve replacement reoperation on patients is mandatory; in aortic valve replacement patients the left ventricular pressure itself can overcome the prosthetic block. Attention should be paid to valve excision and suture techniques as tilting disc prostheses are more vulnerable to extrinsic block. Furthermore, their use is contraindicated in redo operations and mitral valve replacement with total or partial preservation of mitral apparatus.

Adult↗
PubMed1992

Acute thrombosis of prosthetic valves: a multivariate analysis of the risk factors for a lifethreatening event.

In 3231 prosthetic valves implanted between January 1975 and November 1990, we observed 61 cases of prosthetic obstruction of biological origin with clinical and laboratory findings of severe functional impairment which required surgery as emergency treatment. The hospital mortality was 19.67% (12/61). The obstruction was due to a primary thrombosis in all 5 bioprostheses which were not anticoagulated and in 11/56 (19.64%) mechanical prostheses of which 3 were not anticoagulated and 4 were not properly anticoagulated. The obstruction was due to fibrous tissue overgrowth in the other 45 mechanical prostheses (80.35%) with secondary thrombosis in 34 cases (60.71%) and no thrombosis in 11 (19.64%); 71.11% of these prostheses were adequately anticoagulated. Of the 61 obstructed prostheses, 53 were mitral and 8 were aortic. No tricuspid obstruction was observed. A statistical assessment by multiple correspondence, cluster and chi square analysis was performed in two groups of patients with different models of mechanical mitral prostheses. The 5-year actuarial incidence of obstruction was 6.08%. Significant risk factors were: tilting disc prostheses, prostheses without pyrocarbon coating, large prostheses, tilting disc prostheses with a small orifice posteriorly oriented, atrial fibrillation, enlarged left atrium, time from implant greater than 4 years, age between 40 and 50 years. In our opinion, prosthetic obstruction may be referred to a primary thrombosis only in cases where it may be prevented by adequate anticoagulation. In most cases, the obstruction is produced by periprosthetic fibroblastic proliferation which may develop in spite of adequate anticoagulation in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Dissection of the left main coronary artery: diagnosis by angioscopy.

A 58-year-old woman with mitral valve disease was investigated with cardiac catheterization. At catheterization, a suspected dissection of the left main coronary artery occurred. This diagnosis was confirmed at urgent operation by intraoperative angioscopy. The patient underwent mitral valve replacement and coronary artery bypass grafting and made a good postoperative recovery. Coronary angioscopy at operation provides a useful means of diagnosing pathology in the left main coronary artery.

Cineradiography↗
PubMed1990

Coronary artery spasm following coronary artery bypass grafting. Treatment with intracoronary ISDN followed by systemic intravenous nifedipine infusion.

Coronary artery spasm following coronary artery bypass grafting (CABG) has been described previously. The cause and underlying risk factors are mainly speculative and treatment therefore symptomatic. We present the successful management of this condition by administration of an intravenous Nifedipine infusion after intracoronary Isosorbide dinitrate (ISDN) had failed to relieve the spasm.

Angiography↗
PubMed1990

Results of tricuspid valve replacement for nonrheumatic and noninfective disease.

Because of the rarity of isolated, nonrheumatic, noninfective tricuspid valvular disease, the long-term results of treatment by tricuspid valve replacement are uncertain. From June 1967 to April 1986, we implanted 23 biological or mechanical tricuspid valve prostheses in 20 patients for nonrheumatic, noninfective endocarditis. All cases were followed from 1 to 20 years after the procedure, for a total of 215.08 patient-years. There were 2 hospital deaths and 3 late deaths. Actuarial analysis indicated a mortality rate of 1.39% + 1.6% per year. Late morbidity included 3 episodes of prosthetic thrombosis in 2 patients, arrhythmias in 5 patients, and recurrent spontaneous abortions in 1 patient. New York Heart Association Functional Class improved in all survivors. We conclude that tricuspid valve replacement, especially when a bioprosthesis is used, can be performed with a low operative risk and good long-term results in patients who have nonrheumatic, noninfective, valvular disease.

Journal Article↗