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Biomedical subjects

A Sirinelli

Publications and source records attributed to A Sirinelli.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Influence of the valve position on the complications related to pericardial Carpentier-Edwards valve after 8 years].

Between July 1984 and December 1991, 541 Carpentier-Edwards pericardial prostheses were implanted in 536 patients (420 aortic and 121 mitral prostheses). The operative mortality was 2.9% for aortic and 3.3% for mitral valve replacement. All but 8 patients were followed up for an average of 3.9 years, making a total follow-up of 1930 patient-years. There were 61 deaths during follow-up (41 AVR, 20 MVR). The actuarial 8 year survival was 80 +/- 6% for AVR and 74 +/- 10% for MVR. There were 15 deaths related to the prostheses. The probability of absence of valve-related mortality was 97 +/- 3% for AVR and 92 +/- 6% for MVR (NS). The valve-related complications included 15 thromboembolic events (AVR: 12; MVR: 3), 10 endocarditis (AVR: 7; MVR: 3), 8 anticoagulant-related haemorrhages (AVR: 4; MVR: 4), 4 degeneration (AVR: 2; MVR: 2). There were no cases of cusp tear. The probability of absence of thromboembolic events at 8 years was 96 +/- 3% for AVR and 96 +/- 4% for MVR (NS), of absence of endocarditis 97 +/- 2% for AVR and 97 +/- 3% for MVR (NS) and of absence of valve degeneration 99 +/- 1% for AVR and 99 +/- 2% for MVR (NS). These results show that the position of the bioprosthesis had no influence on valve-related morbidity and that pericardium is a satisfactory tissue for the manufacture of mitral bioprostheses.

Actuarial Analysis↗
PubMed1994

New procedure to replace the aortic valve with autologous pericardium: a clinical case.

Primary tissue failure is a major problem with pericardial or porcine heterografts, and the causes of calcification of the tissue are not yet known. The deterioration of bioprostheses may be due in part to immunologic response. Using autologous tissue is a current approach of research. We present a case of replacement of the aortic valve using an original procedure with autologous pericardium.

Aortic Valve↗
PubMed1994

The Carpentier-Edwards pericardial aortic valve: intermediate results in 420 patients.

From July 1984 to December 1991, 420 patients underwent isolated aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis in our Institution. Of the patients 71.5% were male, the mean age was 66.9 +/- 11.9 years and 48% were in NYHA clinical stage III or IV. The operative mortality rate was 2.9% (12/420). All patients but six were followed up for an average of 3.9 years after their operation and total follow-up was 1444 patient-years. At this time of the study, over 80% of the patients are in NYHA class I or II, 6% are in atrial fibrillation and 7% receive anticoagulation treatment. There were 41 late deaths. After 8 years the actuarial survival rate is 80% +/- 6%. Nine patients died of valve-related causes (three endocarditis, three thromboembolic complication, one structural failure, and two sudden deaths). The actuarial rate of freedom from valve-related death was 97% +/- 3% at 8 years. Valve-related complications included 12 thromboembolic episodes (0.8% patient-year), 7 endocarditis (0.5% patient-year), 4 anticoagulant-related complications (0.2% patient-year), 6 reoperations (0.4% patient-year) and 2 structural valve failures (0.1% patient-year). After 8 years, freedom from thromboembolic complication was 96% +/- 3%, from endocarditis 97% +/- 2%, from reoperation 98% +/- 2% and from valve failure 99% +/- 1%. There were only two structural deteriorations (calcification and stenosis) and one explanation. No leaflet tear was observed. We conclude that these intermediate results are better than those obtained with previous pericardial bioprostheses.

Actuarial Analysis↗
PubMed1994

Electrocardiographic and electrophysiologic properties of cardiac allografts.

The increasing number of heart transplant patients requires that physicians be able to recognize the electrocardiographic (ECG) and electrophysiologic properties of cardiac allografts. Cardiac allografts are characterized by modifications of resting ECGs and frequent arrhythmias in the postoperative period, and the loss of autonomic nervous control illustrated by permanent tachycardia and loss of heart rate variability during 24-hour ambulatory ECG recording. Some clinical and experimental observations suggest a mid-term reinnervation of the cardiac allograft, but this requires histologic confirmation. The electrophysiologic characteristics of the denervated myocardium are similar to those of the innervated myocardium at rest. However, supersensitivity to circulating catecholamines has been observed in cardiac allografts as in experimentally denervated hearts, which is responsible for a progressive increase in heart rate during exercise and a slow decrease during recovery. Supersensitivity of the denervated heart to acetylcholine may explain the high prevalence of donor sinus dysfunction due to impairment of its automaticity. More often, the sinus node dysfunction is transient and can be treated with an adenosine antagonist, such as theophylline, before permanent implantation of a pacemaker. In the case of pacemaker implantation, synchronization of the donor atria with the recipient atria is desirable, and an endocardial lead implantation is preferred. Several electrophysiologic changes have been observed during acute cardiac allograft rejection. From experimental studies, the most important of these are the disturbance of conduction in the atria and the atrioventricular node and a decrease in the amplitude of the ventricular potential. Initial studies on isolated myocytes show profound changes in membrane conductance during experimental cardiac rejection. The development of new noninvasive detection methods of cardiac allograft rejection, such as intramyocardial voltage electrogram monitoring and high-resolution ECG, could help early diagnosis.

Animals↗
PubMed1994

[Partial pulmonary embolectomy without extracorporeal circulation. Apropos of a case].

The authors report a case of massive pulmonary embolism compromising the haemodynamic status of a 52 year old man with a formal contraindication to thrombolytic therapy. Unilateral pulmonary embolectomy was performed without cardiac pulmonary bypass, preceded by partial interruption of the inferior vena cava. Postoperative controls confirmed the success of the surgical procedure. Although the indications of surgical embolectomy are limited, especially without cardiopulmonary bypass, it may be considered for the treatment of certain cases of massive pulmonary embolism.

Cerebral Hemorrhage↗
PubMed1993

[Non-invasive exploration methods of supraventricular arrhythmia in current practice].

In patients with supraventricular rhythm disorders ambulatory electro-cardiographic recording (Holter system) is an indispensable examination as it detects attacks that pass unrecorded by conventional ECG, being asymptomatic, too brief or too rare. It confirms the diagnosis, defines the factors triggering the attacks, detects the association of rhythm and conduction disorders, guides the treatment and monitors its effectiveness. Sequential ambulatory recording lends itself particularly well to this last objective. Biochemical examinations explain the cause of certain relapses (potassium depletion, high alcohol blood level) or detect the origin, clinically more or less obvious, of these disorders of rhythm (essays of thyroid hormones). Measuring blood levels of therapeutic drugs makes the handling of these various drugs safer. Finally, echocardiography detects an underlying heart disease, evaluates the size of the left atrium (a factor of relapse when it is dilated and of embolism when it harbours thrombi) and assesses the left ventricular function before administration of antiarrhythmics which, to varying extents, are all negative inotropic drugs.

Arrhythmias, Cardiac↗
PubMed1992

[Efficacy and tolerance of propafenone in the prevention after a year of recurrent atrial arrhythmia. Results of a multicenter study of 114 patients].

One hundred and fourteen patients were included in an open multicenter trial of the prevention of atrial arrhythmias by propafenone and of the tolerability of this anti-arrhythmic agent after a year. The study population was divided into two groups: group I of 45 patients with only runs of arrhythmias and group II of 69 patients with a stable arrhythmia. Patients were seen again after 2 weeks, 3 and 6 months and 1 year. Holter records were obtained routinely in group I and at 6 months in group II. Treatment was stopped for inefficacy in 30 patients (10 of group I, 20 of group II), for intolerance in 10 patients (5 in each group) and for both in 3 patients (1 in group I, 2 in group II). Propafenone was considered to be effective and well tolerated in 55 per cent of patients, this success rate being identical in the two groups. Effectiveness persisted in a stable fashion at 1 year in those patients who responded initially.

Adolescent↗
PubMed1988

Mode of action of antiarrhythmic drugs and the implicated arrhythmogenic risk.

The mode of antiarrhythmic action of drugs usually cannot be extrapolated from their electrophysiologic properties despite extensive in vitro and in vivo assessment: in most cases, the mechanism of arrhythmias remains uncertain and cannot be established by clinical evaluation including electrophysiologic study; in specific cases where the arrhythmia substrate is fully described, the exact origin of antiarrhythmic action is unknown, especially when chronic preventive treatment is considered where triggering events are probably important. Nevertheless, the profound electrophysiologic changes resulting from antiarrhythmic drugs alter several delicate balances, at the cellular level (repolarizing and depolarizing currents) and at the tissue level (refractory period/conduction time ratio). Some afterdepolarizations can be elicited, especially when repolarization is delayed by long cycle lengths and K+ current inhibition; reentry is enhanced when conduction impairment occurs without similar change in refractoriness. Proarrhythmic effects of drugs seem to relate to these alterations and caution should be exerted when ECG shows drug-induced QT or QRS prolongations.

Animals↗
PubMed1987

Phase mapping of radionuclide gated biventriculograms in patients with sustained ventricular tachycardia or Wolff-Parkinson-White syndrome.

Accuracy of Fourier phase mapping of radionuclide gated biventriculograms in detecting the origin of abnormal ventricular activation was studied during ventricular tachycardia or preexcitation. Group I included six patients suffering from clinical recurrent VT; 3 gated blood pool studies were acquired for each patient: during sinus rhythm, right ventricular pacing, and induced sustained VT-Group II included seven patients with Wolff-Parkinson-White syndrome and recurrent paroxysmal tachycardia; 3 gated blood pool studies were acquired for each patient: during sinus rhythm, right atrial pacing and orthodromic reciprocating tachycardia. Each acquisition lasted 5 min, in 30 degrees-40 degrees left anterior oblique projection. In Group I, the Fourier phase mapping was consistent with QRS morphology and axis during VT (5/6), except in one patient with LV aneurysm and LBBB electrical pattern during VT. Origin of VT on phase mapping was located in the right ventricle (n = 2) or in left ventricle (n = 4), at the border of wall motion abnormalities each time they existed (5/6). In Group II, the phase advance correlated with the location of the accessory pathway determined by ECG and endocardial mapping (n = 6) and per-operative epicardial mapping (n = 1). Discrimination between anterior and posterior localisation of paraseptal pathways and location of intermittent preexcitation was not possible. We conclude that Fourier phase mapping is an accurate method for locating the origin of VT and determining its etiology. It can help locate the site of ventricular preexcitation in patients with only one accessory pathway; its accuracy in locating multiple accessory pathways remains unknown.

Adult↗
PubMed1987

Cytogenetic studies in twelve patients with primary myelofibrosis and myeloid metaplasia.

Chromosome studies on bone marrow and/or peripheral blood cells without phytohemagglutinin were performed on 12 patients with primary myelofibrosis with myeloid meta-plasia (PMMM) between 1980 and 1984. Abnormal clones were found in six patients (50%). In five cases the abnormal clone involved the long arm of chromosome #7, two of which also had partial trisomy of chromosome #1 and trisomy of 9. Additional abnormalities involving chromosomes #3, #5, #11, #13, #15, and #21 were each found once. Review of the literature showed few studies on the cytogenetics of PMMM. No specific chromosomal pattern can be established; however, abnormalities described are nonrandom.

Aged↗
PubMed1987

[Cardiac metastases. Clinical arguments of the diagnosis].

The case reported here concerns an 80-year old man without history of coronary disease whose electrocardiogram showed localized and stable repolarization disorders, viz. elevated ST segment with isoelectric point J and negative T wave. This pattern suggested cardiac metastasis after chest examination had revealed a bronchial epidermoid carcinoma. Two-dimensional echocardiography showed that the lateral wall of the left ventricle was thickened, hyperechogenic and akinetic. The secondary cardiac lesions were confirmed at pathological examination. This case has prompted us to discuss the frequency of such secondary tumours of the heart, their mode of dissemination to the myocardium and their clinical and electrocardiographic aspects. It underlines the usefulness of echocardiography for the diagnosis of cardiac tumours.

Aged↗
PubMed1986

Acute leukemia after treatment for ovarian cancer. Report of four cases and review of the literature.

Four cases of acute nonlymphocytic leukemia (ANLL) following ovarian cancer are reported. All patients received alkylating agents and had a preleukemic phase. Seventy-nine additional cases of ANLL following therapy found in the literature are also reviewed. All but 2 patients received alkylating or alkylating-related agents alone or in combination. Mean duration of chemotherapy was 31.4 +/- 19.4 months. Eighty-eight percent of the patients presented with preleukemia with a mean duration of 10 +/- 10 months. Mean interval between cancer and ANLL was 57.3 +/- 26 months. Cytogenetic abnormalities were found in 71% among patients who had a karyotype. Long-term alkylating agent therapy seems to have a significant role in the development of ANLL and should be avoided in ovarian cancer.

Aged↗