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Biomedical subjects

B Marino

Publications and source records attributed to B Marino.

At least 109 records · Page 6Linked to original sources
PubMed1996

Associated cardiac anomalies in isolated and syndromic patients with tetralogy of Fallot.

To detect in children with tetralogy of Fallot (ToF) the prevalence of associated cardiac anomalies in syndromic and isolated cases, the additional cardiac defects of 150 consecutive patients with ToF (102 isolated and 48 syndromic cases) were evaluated by review of echocardiographic, angiocardiographic, and surgical reports. Syndromic patients were classified into groups with branchial arch defects, Down syndrome, and other genetic conditions. ToF is significantly associated with additional cardiac malformations in patients with branchial arch (11 of 21, p <0.01) and Down (10 of 20, p <0.0001) syndromes. The subarterial ventricular septal defect with deficiency of the infundibular septum (4 of 21, p <0.01) and the right aortic arch (6 of 21, p <0.05) were prevalent in patients with branchial arch syndromes, whereas atrioventricular canal (10 of 20, p <0.0001) was associated with ToF in patients with Down syndrome. Peculiar anatomic cardiac patterns are present in children with ToF and may alert the cardiologist to look at additional cardiac anomalies. Moreover, the presence of some associated cardiac anomalies may suggest careful clinical evaluation for genetic syndromes.

Adolescent↗
PubMed1996

Partial atrioventricular canal with congestive heart failure in the first year of life: surgical options.

BACKGROUND: An important subgroup of patients with partial atrioventricular canal require an operation in the first year of life because of refractory congestive heart failure. METHODS: From June 1982 to April 1995, of 128 patients with partial atrioventricular canal, 35 patients (27%) underwent surgical treatment at less than 1 year of life. Associated cardiac anomalies were present in 22 patients. Only 7 patients (20%) had Down's syndrome. Five patients with left ventricular hypoplasia underwent aortic coarctectomy (3 patients) or Norwood operation (2 patients). The other 30 patients underwent anatomic repair in 24 cases and aortic coarctectomy in 6. The surgical results of patients submitted for anatomic repair were retrospectively correlated with the echocardiographic mitral valve diameter. RESULTS: There were 7 deaths (29%) after anatomic repair, 2 (22%) after aortic coarctectomy, and 2 (100%) after Norwood operation. Infants with a mitral valve diameter less than 2.5 x 10-2 m/m2 died at repair. In a mean follow-up of 73.5 months there were five secondary mitral valve plasties and three repairs after aortic coarctectomy. CONCLUSIONS: Among patients with partial atrioventricular canal, there is an important subgroup with clinical signs of heart failure in the first year of life. Left-sided obstructive lesions and complex mitral valve anomalies seem to play a fundamental role in the clinical evolution and prognosis of these patients. The echocardiographic mitral valve diameter may be useful for determining the correct surgical indication.

Aortic Coarctation↗
PubMed1996

Patient selection for repair of complete atrioventricular canal guided by echocardiography.

OBJECTIVE: Two-dimensional, Doppler and color-flow echocardiography is accepted as a safe diagnostic tool to guide the surgical treatment of certain congenital heart defects. Its role for surgical indication in patients with complete atrioventricular canal (cAVC) is described in this paper. METHODS: Between July 1989 and January 1995, 80 patients with cAVC underwent primary repair in our Institution. In 73 surgery was guided only by echocardiography (Group I), while in the remaining 7 patients (Group II) cardiac catheterization was performed because of unclear diagnosis and/or suspected associated malformations. RESULTS: Echocardiography showed an overall sensitivity of 100% and specificity of 93% in detecting associated malformations. DISCUSSION: Based on these data and on the knowledge of the natural history of pulmonary vascular changes in patients with cAVC we think that echocardiography might be adequate for selection of infants with uncomplicated forms of cAVC for primary repair.

Child, Preschool↗
PubMed1996

Return to work and quality of life measurement in coronary artery bypass grafting.

OBJECTIVE: Coronary bypass surgery (CABG) is effective in relieving angina and restoring expectation of life in patients with coronary artery disease. The aim of this work was to evaluate the effects of CABG on the quality of life (QL) and return to work (RW). Medical and non-medical variables influencing QL and RW were investigated. The results were compared with those of medically treated patients. METHODS: Five hundred fifty patients with chronic stable angina undergoing coronary angiography, were consecutively and prospectively enrolled in the study. Coronary lesions narrowing the lumen by more than 70% were considered significant. Questionnaire interviews were performed in hospital on admission and after at least 6 months follow-up. The QL interviews were based on quantitative evaluation of five conceptual dimensions: General Well-Being Schedule, Physical Symptoms Distress Index B, Sexual Satisfaction Unified Test, Social Participation and Work Performance and Satisfaction. Whether the patient had returned to work was recorded at each interview. Patients with significant coronary lesions were electively assigned to surgical (group A) or medical therapy (group B). The indications for surgical therapy were: triple-vessel disease, left main, ejection fraction (EF) less than 50%, angina resistant to medical therapy. Patients with non-significant coronary lesions, poor left ventricular function (EF < 25%) and combined valvular and coronary disease were excluded from the study. Patients scheduled for PTCA were also excluded. RESULTS: Two hundred forty-six patients were assigned to group A, 200 to group B, 26 had non-significant coronary lesions, 16 combined valve and coronary disease, 15 poor left ventricular function and 78 were scheduled for PTCA. The mean follow-up for the two groups was 38 +/- 6 months. At in-hospital admission group A patients had overall worse QL perception, while at follow-up control the improvement in QL test was statistically significant. The group A mean RW rate was statistically significant, subgroup analysis showed a higher RW rate in patients without angina, working before surgery, under 50 years old, literate and with a professional or executive employment before surgery. At follow-up group B QL perception showed a positive trend, but not statistically significant. The group B RW rate was higher than that of group A, subgroup analysis did not show statistically significant data. CONCLUSIONS: Our findings demonstrate that patients undergoing elective CABG surgery show early physical and psychological improvement. Specific rehabilitation programs can be useful in selected subgroups of patients.

Adult↗
PubMed1996

Inhaled nitric oxide in patients with severe heart failure: changes in lung perfusion and ventilation detected using scintigraphy.

Inhaled nitric oxide (NO) is a selective pulmonary vasodilator in patients with end-stage cardiac failure. Preoperative high pulmonary vascular resistance could modify early and late results after heart transplantation generally due to right-ventricular failure. Aim of this study was to assess pulmonary vascular resistance variability following inhalation of NO by using a scintigraphic method. Our preliminary results suggest that inhaled NO in patients with end-stage heart failure redistributes blood away from apical regions and towards more basal and posterior segments, probably dilating blood vessels in ventilated but nonperfused zones. NO may represent a simple and reliable method to evaluate dynamic response of pulmonary vasculature.

Administration, Inhalation↗
PubMed1996

Nitroglycerin-induced changes in myocardial sestamibi uptake to detect tissue viability: radionuclide comparison before and after revascularization.

BACKGROUND: Nitroglycerin (NTG) is known to increase the blood supply to the myocardium, and would thus increase the delivery of a perfusional tracer such as sestamibi (MIBI) to the tissue. The latter, in turn, would take up and concentrate the tracer to a greater extent than in basal conditions only if energy-dependent mechanisms were still available-that is, only if the cells were still viable. METHODS: We evaluated the changes that intravenous administration of NTG induced on the uptake of MIBI by akinetic myocardial areas, using tomographic perfusional imaging in 23 patients with previously ascertained anterior myocardial infarction who were undergoing myocardial revascularization procedures. Changes in uptake were compared with echocardiographic and perfusional changes occurring after operation. RESULTS: The improvement of MIBI uptake after NTG correctly identified 12 of the 16 patients (75%) showing postoperative wall motion improvement; they comprised 12 of the 14 (86%) patients with NTG-induced increase in MIBI uptake who showed improved wall motion after operation. A close correlation (r = 0.88, P < 0.001) was found between the increase in myocardial MIBI uptake induced by NTG infusion and that induced by revascularization. The presence of collaterals to the akinetic area was associated with a significantly (P < 0.01) greater increase in MIBI uptake both during NTG infusion and after operation. CONCLUSIONS: The results of this study suggest that MIBI perfusional myocardial scintigraphy during infusion of NTG is capable of detecting viable but chronically hypoperfused myocardium, predicting postoperative wall motion and perfusional improvement, and reflecting the postoperative pattern of perfusion. The best results were achieved in patients with evidence of collateral circulation supplying the infarcted area.

Cardiac Catheterization↗
PubMed1996

Quantitative light microscopic detection of Enterocytozoon bieneusi in stool specimens: a longitudinal study of human immunodeficiency virus-infected microsporidiosis patients.

The clinical course of microsporidiosis caused by Enterocytozoon bieneusi and the pattern of intestinal shedding of spores have not been correlated, at least in part because detection of E. bieneusi in stools is more difficult than detection of other protozoa because of its smaller size and less intense staining. We examined with a modified trichrome stain 124 stool specimens collected over a 2-year follow-up period from 23 human immunodeficiency virus-infected patients with electron microscopic-proven E. bieneusi infection and correlated the results with electron microscopic observations from duodenal biopsy specimens taken at the beginning of the study period. E. bieneusi was detected in the stool at least once in 74% (17 of 23) of all patients, in 100% (9 of 9) of patients in whose tissue moderate or abundant numbers of parasites were seen, and in 57% (8 of 14) of patients in whose tissue few parasites were seen. In two patients with abundant tissue parasites, many microsporidia were detected in every stool specimen (13 of 13) during the follow-up period, whereas among the patients with few tissue parasites, only 23% (15 of 64) of stool specimens were positive. Furthermore, if spore stages as well as plasmodial stages were detected in tissue, stool specimens were more likely to be positive. Although most of the heavily infected stools were from patients with chronic diarrhea, microsporidia were detected in 33, 28, and 42% of stool specimens from patients with nil, intermittent, and chronic diarrhea patterns, respectively. Although quantitation of E. bieneusi spores in stool specimens was closely correlated with quantitation in tissue, it was not correlated with reported patterns of diarrhea.

AIDS-Related Opportunistic Infections↗
PubMed1996

Orocardiodigital syndrome: an oral-facial-digital type II variant associated with atrioventricular canal.

We report on a patient with a constellation of anomalies including hamartomas of the tongue, polysyndactyly, and atrioventricular canal. A similar association has been previously described by Orstavik et al in two sibs. The clinical spectrum of the oralfacial-digital syndrome (OFDS) type II includes all these features. In particular, congenital heart defect, mainly atrioventricular canal, has been described in a few cases. It has been previously suggested that these latter patients may be affected by a variant of OFDS type II. We propose to distinguish this orocardiodigital variant and point out the association of the syndrome with atrioventricular canal.

Adult↗
PubMed1996

Quality of life following coronary bypass surgery.

Quality of Life (QL) following coronary bypass surgery (CABG) can be modified by medical and non-medical factors (i.e., functional class, medical therapy, psychological changes, economic status, educational level, return to work, country origin). The aim of this study was to evaluate QL in 203 patients that underwent CABG (Group A). QL perception was assessed by 5 questionnaires self-rated by the patient. Data obtained by surgical series were compared with 107 patients with coronary artery disease and treated medically (Group B), and a population of 102 normal subjects (Group C). Our findings demonstrated that general well-being, functional status and social participation improved in Group A. Sexual activity decreased in Group A. CABG did not modify job satisfaction. Chest pain was the main variable influencing negatively return to work; age, work before CABG, low educational level and country area were negatively related non medical variables. Work resumption rate decreased significantly in patients over 50 years, in those coming from the south of Italy and also with low educational level.

Age Factors↗
PubMed1996

A role for nitric oxide in the vasoplegic syndrome.

INTRODUCTION: Cardiopulmonary bypass (CPB) is frequently associated with hemodynamic disorders caused by a whole blood inflammatory response. In particular vasoplegic syndrome occurs in the immediate postoperative time of patients who underwent normothermic CPB. Nitric oxide (NO) was described as an endothelium derived relaxing factor (EDRF). We report changes in NO concentration occurred in patients who experienced vasoplegic syndrome following CPB. MATERIALS AND METHODS: We analyzed changes in NO concentration in 95 consecutive patients who underwent coronary artery bypass grafting under normothermic CPB. NO was measured as nitrite plasma level (NPL) by the Griess reaction. RESULTS: In all cases a significant NPL increase 30 minutes after starting CPB and 10 minutes after CPB interruption was observed (p<0.005). No significant differences were measured 60, 120 and 240 min after CPB interruption when compared with before CPB. Three patients experienced vasoplegic syndrome and NPL values measured at 60, 120 and 240 min after CPB interruption were still significantly increased when compared with before CPB (p<0.005). CONCLUSION: NO plays a role in the CPB-related hemodynamic disorders. Use of NO synthase inhibitors could provide a better management of vasoplegic phenomenon following CPB.

Cardiopulmonary Bypass↗
PubMed1996

Atrial natriuretic peptide in normotensive and hypertensive heart transplanted patients.

AIM OF THE STUDY: The present study is aimed to investigate the 24-hour pattern of Atrial Natriuretic Peptide (ANP) plasma concentration in normotensive (N) and hypertensive (H) heart transplanted patients (HTP) in order to detect the pathophysiological role of blood pressure regimen for ANP increase in HTP. METHODS: Eight NHTP and five HHTP have been investigated, all being hemodynamically compensated, without histological evidence of rejection and treated by Cyclosporine, Azathioprine and Prednisone. The control group was constituted by 10 clinically healthy subjects (CHS). ANP was assayed six times over the 24 h span. The contrasts between groups were statistically analyzed by means of Student's t-test for the 24 h mean values. RESULTS: The t-test found a statistically significant difference between the ANP 24 h mean levels either of CHS and HTP or NHTP and HHTP. The ANP 24 h mean plasma levels are increased of 190.4% in HHTP and of 44.3% in NHTP in comparison with CHS. DISCUSSION: The findings suggest that the further elevation of ANP in HHTP is a compensatory mechanism to antagonize high blood pressure. Moreover, being the ANP percent increase in HHTP three times more.

Adult↗
PubMed1996

[Describing and interpreting systemic hypertension in heart transplantation with non-invasive arterial pressure monitoring].

This investigation was performed in 34 heart transplanted patients (HTP), 28 males and 6 females, mean age 49 +/- 13 years. The aim of the study was to detect hypertension in HTP by casual sphygmomanometry and non-invasive ambulatory blood pressure monitoring (ABPM). The evaluation of ABPM demonstrated that 71% out of the HTP was hypertensive because of some elevated blood pressure values scattered during the hours of the day and/or of the night. These hypertensives were found within the groups of normotensives as well as of hypertensives considered to be correctly treated. Fifty percent hypertensive HTP did not show the physiologic nocturnal decrease in blood pressure (non-dippers); 25% out of the non-dipper hypertensives showed absence of the blood pressure circadian rhythm, demonstrating that their hypertension was prevalently nocturnal and could not be detected by casual sphygmomanometry-The ABPM is recommended in clinical follow-up of HTP for a correct diagnosis of hypertension, which frequently complicates heart transplantation, and with the aim of avoiding hypertensive damage of the transplanted organ. The ABPM is useful for adjusting the antihypertensive therapy, in order to restore the blood pressure circadian rhythm.

Adult↗
PubMed1996

[Hypertensive cardiac damage in heart transplantation. A noninvasive monitoring study of arterial pressure].

This study is aimed at investigating the relationship between cardiac hypertrophy and blood pressure (BP) 24-h pattern in 34 heart transplanted patients (HTP), 9 out of them (26%) being considered as normotensives, the other ones (74%) being regarded as hypertensives under adequate treatment, via casual sphygmomanometry. The study is an attempt to explain the occurrence of at least one sign of hypertrophic cardiopathy in 20 cases (59%), hypothesizing the presence of false normotensives among the putative normotensives and presumably-cured hypertensives. The ambulatory BP monitoring was able to identify 7 hypertensives (78%) among the putative normotensives, and 17 not well-cured subjects (68%) among the presumably cured hypertensives. At least one sign of cardiac hypertrophy was found in 5 (50%) of the 10 true normotensives, who were all non-dipper, and in 15 (63%) of the 24 hypertensives. The 9 hypertensives without cardiac hypertrophy (37%) had developed hypertension very recently. These findings stress the role of the ambulatory BP monitoring as a diagnostic tool during the follow-up of HTP, in order to identify the false normotensives as well as the not well-treated hypertensives. This role can contribute to optimize the prophylaxis of hypertensive damage for the transplanted heart.

Adult↗