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Biomedical subjects

C Di Mario

Publications and source records attributed to C Di Mario.

At least 181 records · Page 10Linked to original sources
PubMed1988

Percutaneous balloon valvuloplasty for calcific aortic stenosis. A treatment 'sine cure'?

Twenty-five elderly patients with calcific aortic stenosis, 12 male (48%) and 13 female (52%), mean age 74.8 +/- 7.6 years, underwent percutaneous aortic balloon valvuloplasty between March 1986 and September 1987. Twenty-two patients (88%) were in class III-IV of the New York Heart Association, 13 (52%) had a history of previous angina and 7 (28%) of syncopal attacks. All patients had been considered either unsuitable or high-risk candidates for aortic-valve replacement because of age or associated diseases. Balloons of increasing size (area ranging from 1.3 to 3.8 cm2 during inflation) were successively passed retrogradely from the femoral artery and manually inflated to 3-7 atmospheres. Inflation duration ranged from 15 to 260 s (mean 40 s). Post-dilatation there were significant changes in left ventricular peak-systolic and end-diastolic pressures (P less than 0.00001 and P less than 0.01, respectively), mean systolic aortic transvalvular gradient (from 73 to 43 mmHg, P less than 0.000001), mean systolic aortic flow (from 176 to 208 ml s-1, P less than 0.0001) and aortic valve area (from 0.47 to 0.72 cm2, P less than 0.000001). Major complications included: in-hospital deaths of two patients (8%) admitted in cardiogenic shock; left haemiplegia (4%); transient haemianopia (8%); development of grade III aortic insufficiency (4%); and persistent complete atrioventricular block (4%). Complications at the puncture-site occurred in 7 patients (28%)--including two femoral pseudoaneurysms and the need for surgical removal of a balloon remnant after rupture in one patient. No local haemorrhagic complications were observed in the latter eight procedures, performed using a 16.5 French 100-cm long arterial introducer. At a mean follow-up of 13.0 +/- 5.0 months, an important functional improvement persisted in 14 patients (56%), no major changes in pre-valvuloplasty symptoms were observed in 3 patients (12%), while five patients (20%) required surgical treatment after a successful valvuloplasty because of recurrence of symptoms (late valve restenosis). Percutaneous aortic balloon valvuloplasty is a possible palliative therapy in elderly patients with calcific aortic stenosis. However, its inherent immediate risk, limited haemodynamic result and the possible development of valve restenosis at medium-term follow-up, suggest that the application of this technique should be limited to poor surgical candidates.

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PubMed1988

Coronary aneurysms in a case of Ehlers-Danlos syndrome.

An asymptomatic 48 year old man had transient T-wave inversion in the anterolateral leads after nonpenetrating chest trauma. Both the patient and his 6 year old son showed the typical skin hyperelasticity and joint hyperextensibility of the Ehlers-Danlos syndrome, suggesting autosomal dominant inheritance. The coexisting cardiac abnormalities of the patient included multiple coronary aneurysms, mitral valve prolapse with slight regurgitation, fusiform dilatation of the ascending aorta with moderate insufficiency and left anterior hemiblock. A routine noninvasive cardiovascular evaluation should be performed in all patients with Ehlers-Danlos syndrome in order to exclude valvular heart disease and dilatation of the aortic root or of other vessels, including the coronary arteries.

Aorta↗
PubMed1988

[Short- and medium-term study of arterial grafts and native coronary circulation after in situ implant of the internal mammary artery].

The internal mammary artery (IMA) is being increasingly utilized as a conduit for myocardial revascularization, based on its higher long-term patency. The aim of this study is the serial assessment of the changes of native coronary vessels after IMA coronary anastomosis. Twenty-six consecutive patients (24 males and 2 females, mean age 56.4 years) received an IMA graft on the left anterior descending (LAD) artery. IMA coronary anastomosis was single in 11 patients and double (LAD and diagonal branch) in the remaining 15 cases. In 23 patients (88.5%) at least one associated saphenous vein graft was inserted. Post-operatively, no new Q waves or low-output syndromes were observed. Follow-up angiographic study, including selective opacification of the IMA graft, was carried out after 1 month and after 1 year. The cumulative patency rate of IMA grafts was 97.7% after 1 month. The LAD stenosis proximal to the IMA anastomosis progressed to total occlusion in 6 patients (28.5%), all of them with a preoperative stenosis ranging from 90 to 99%; its diameter remained unchanged in 6 patients (28.5%), while a reduction of the coronary narrowing greater than or equal to 20% was observed in 9 patients (43%). Preoperatively, the LAD stenosis of the latter groups ranged from 70 to 90%. Severity of residual stenosis and relative diameters of LAD artery and IMA graft influenced the competitive flow distribution through these vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Evaluation of flow reserve in internal mammary artery in situ bypass].

The internal mammary artery, when used as a conduit for coronary artery bypass, offers a better long-term patency and survival rate than the saphenous vein. However, concern exists that the flow through the internal mammary artery may be inadequate during periods of peak myocardial demand. This flow was investigated in 18 consecutive patients who were selected for coronary bypass of the left anterior descending artery using the internal mammary artery. All patients were evaluated post-operatively within 12 months by means of graded maximal stress test, cardiac catheterization and exercise thallium-201 scintigraphy. Significant improvement in work capacity, maximal rate-pressure product, effort angina and ECG abnormalities during exercise stress testing were observed following internal mammary artery myocardial revascularization. The patency rate for internal mammary artery grafts was 100% (vs 85% for vein grafts); during the followup period, occlusion of a saphenous vein bypass or development of a new stenosis in a native coronary artery was noted in five patients, and two patients were classified as having partial revascularization. Ischemia, demonstrated by perfusion deficits at peak stress which disappeared in the 3-hour delayed film, was documented in 7.4% (4/54) of the areas supplied by internal mammary artery grafts, compared to 31% (13/42) of the regions revascularized using saphenous vein conduits. Although this result was not statistically significant, a definite trend is suggested. We conclude that ischemia demonstrated by stress thallium scintigraphy in the post-operative period is uncommon when an internal mammary artery graft has been used. This suggests that adequate coronary flow exists at peak myocardial demand during exercise.

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PubMed1987

Restenosis 3 months after successful percutaneous aortic valvoplasty. A clinicopathological report.

A 76-year-old man with severe, calcific aortic stenosis experienced recurrence of symptoms 3 months after a successful percutaneous aortic valvoplasty. Echo Doppler revealed a marked increase of peak aortic flow velocity as compared with the immediate post-valvoplasty value. The patient underwent an uncomplicated aortic valve replacement. Adjacent to fragmented calcification, histology demonstrated a scarring reaction which might well be a major factor in the restenosis process.

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PubMed1987

Percutaneous aortic balloon dilatation for calcific aortic stenosis in elderly patients: immediate haemodynamic results and short-term follow up.

Eight elderly patients (mean (SD) age 72.6 (8.5) years) with severe calcified stenosis of the aortic valve were considered for transluminal balloon dilatation in the Thoraxcenter between March and November 1986. In one patient the procedure could not be performed because of technical difficulties. Balloons of increasing diameter (13-25 mm) were successively passed retrogradely from the femoral artery and manually inflated with pressures of 400-600 kPa (4-6 atmospheres). Post-dilatation, there were significant changes in left ventricular pressures (from 237/21 to 204/13 mm Hg), mean systolic gradient (from 66 to 41 mm Hg, systolic aortic flow (from 172 to 202 ml/s, and aortic valve area (from 0.47 to 0.74 cm2); the cardiac index did not increase significantly (from 2.4 to 2.5 l/min/m2). One patient developed a pseudoaneurysm at the site of the femoral artery puncture that required surgical repair two months after the procedure; one patient experienced an acute left hemianopia during the procedure but had almost completely recovered at discharge. Five patients maintained a clinical improvement at a mean follow up time of 4.5 months after the procedure; two patients underwent aortic valve replacement, one because of minimal haemodynamic improvement after aortic balloon dilatation and persistence of severe dyspnoea and the other because of late recurrence of symptoms caused by restenosis after a successful procedure. Aortic balloon dilatation provides an alternative treatment for patients who are poor surgical candidates for cardiac or extracardiac reasons. At this stage the limited haemodynamic improvements suggest that the treatment can only be regarded as palliative, although proposed technical advances may achieve better immediate results in the future. Long term follow up is needed to evaluate the usefulness of this technique.

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PubMed1987

[Myocardial infarct before 45 years of age: significance of the coronarographic study in asymptomatic patients].

The aim of our study was to evaluate the significance of coronary arteriography in young asymptomatic patients after myocardial infarction. Among a total of 586 consecutive patients who underwent left ventriculography and coronary angiography because of coronary heart disease during the period from January 1984 to June 1986, we selected 51 patients (8.7%) under 45 years of age (range 28-45 years) and without angina, dyspnea or electrocardiographic signs of myocardial ischemia during bicycle ergometric stress test. These patients, 50 males (98.0%) and 1 female (2.0%) were angiographically evaluated from 1 to 12 months after a first myocardial infarction. Coronary occlusions greater than or equal to 70% were found in 44 patients (86.3%): 36 of them (70.6%) had single-vessel disease, 6 (11.8%) double-vessel disease and only 2 (3.9%) triple-vessel disease; no coronary obstructions greater than or equal to 50% of the left main coronary artery were found. Among the 7 patients without critical stenoses (13.7%) 3 had "normal" coronary arteries, 3 noncritical stenoses and one presented an anomalous origin of the left circumflex artery from the right sinus of Valsalva. Only 1 patient underwent surgery. In conclusion, in young asymptomatic patients after a myocardial infarction coronary arteriography may identify a small group either without or with minor atherosclerotic involvement of the coronary tree, while the presence of a localized disease is confirmed in most patients. Therefore, in this selected subgroup, coronary angiography has a limited usefulness in defining high-risk patients possibly requiring surgical treatment.

Adult↗
PubMed1983

[Outcome of aortocoronary bypass in old age].

43 patients over 60 years of age underwent an aortocoronary bypass operation between 1974 and 1977. The observation period after surgery ranged from 4 to 7 years. Clinical results of this group were compared with the results of a group who presented with the same presurgical and surgical characteristics, randomly chosen between 212 patients under 60 years of age operated on in the same period. Surgical mortality was 16.2%, higher than that of the control group (5.5%); similar and very low is the late mortality in both groups (average follow-up on 5.3 years): 2.9% vs 5.5%. The effects on angina are favourable: 79.4% of elderly patients are free from angina and improvement in symptoms is present in all; left ventricular failure is rarely present (7.6%); congestive heart failure is absent. Moreover we pointed out the efficacy of the aortocoronary bypass on return to work. These results lead to a more favourable attitude towards operation in subset of patients showing serious symptoms of coronary heart disease in old age.

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