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Biomedical subjects

C Marcelletti

Publications and source records attributed to C Marcelletti.

At least 127 records · Page 7Linked to original sources
PubMed1977

Early and late results of surgical repair of truncus arteriosus.

Ninety-two patients had corrective operation for truncus arteriosus between 1967 and 1975. During the first 30 days after surgery, 23 patients died. No significant differences appear between early mortality and sex, type of truncus, variations in pulmonary arterial anatomy, truncal valve regurgitation, associated anomalies, previous operation, or duration of extracorporeal circulation. Greater risk is probably encountered with the higher but still operable levels of pulmonary resistance. Reoperation has been required in three patients. Fifty-nine percent of survivors are symptom-free, with all but two of the remainder (38%) being in NYHA functional class II. The late result is suggestively less satisfactory in patients with significant preoperative truncal valve regurgitation. Some late complications related to deterioration of the earlier aortic homograft conduit may be avoided by use of a porcine valve Dacron conduit. The current operative mortality of 9%, and the well-being of 97% of surviving patients suggest the continued advisability of recommending operation for appropriate patients.

Adolescent↗
PubMed1977

Correction of the univentricular heart having two atrioventricular valves.

Problems associated with the early evolution of corrective operation (septation) for univentricular heart (single or common ventricle) are illustrated in a total experience of 36 such operations, 30 of which were recent. Complete heart block existed preoperatively in five of the 30 patients and developed at operation in another 10; only two of these 15 patients attained a satisfactory result. Associated pulmonary stenosis was present in 16 patients, and this seemed to influence the result favorably. An extracardiac conduit between the right-sided ventricular chamber and the distal pulmonary trunk was employed in 20 patients. The presence of associated anomalies, including function of the atrioventricular valves in seven, had a highly unfavorable influence on the result. Although all seven of the most favorable candidates attained a satisfactory result, only 13 (43 percent) in the total group of 30 attained a satisfactory result. Further evolution of this operation, as in previous operations for complex congenital heart disease, should provide more results that are satisfactory.

Adolescent↗
PubMed1976

Repair of traumatic aortic arch to innominate vein fistula under deep hypothermia and circulatory arrest.

Penetrating injuries of the thoracic aorta are usually rapidly lethal. Few patients survive for long enough to undergo surgical treatment. When penetrating injuries of the thoracic aorta are complicated by arteriovenous fistula a correct preoperative diagnosis is important for adequate planning of the surgical repair, and so selective angiography is essential. The best approach is through a median sternotomy with the use of total cardiopulmonary bypass with or without deep hypothermia and circulatory arrest. Fistulae between aorta and innominate vein invariably lead to congestive cardiac failure. A review of the literature suggests that signs of cardiac failure rarely appear early. Congestive failure developed within 30 days of the initial trauma in only two of the 12 reported cases. In our case, the early onset of cardac failure refractory to therapy and the appearance of an expanding pulsatile mass at the base of the neck, threatening rupture, necessitated emergency surgical treatment.

Aorta, Thoracic↗
PubMed1976

The natural history of truncus arteriosus.

The cases of 23 patients whose condition was diagnosed as truncus arteriosus, type I or II, and who were seen at the Mayo Clinic during the decade preceding 1967, that is, before corrective operation became feasible, were reviewed. Ten were infants (through one year of age), and all ten have died. Eight ranged in age from more than one year through seven years of age, and all are living, except one, who diet 11 years after diagnosis. Five were older than seven years, and all had severe pulmonary vascular obstructive disease; three have died. Thus, 14 of the 23 have died, and all but one surviving patient have mild to moderate disability. The generally grave prognosis for patients with truncus arteriosus warrants continued use of corrective operation, but suggests that the greatest benefit can be realized by successful correction in the infant with congestive heart failure and in early childhood before the development of severe pulmonary vascular obstructive disease.

Adolescent↗
PubMed1976

The Rastelli operation for transposition of the great arteries. Early and late results.

Fifty-nine patients had corrective operation of the Rastelli type for transposition of the great arteries between 1968 and 1975. In 121 patients (35 per cent), the ventricular septal defect was enlarged by excising a portion of the septum. During the first 30 days after the operation, II patients (19 per cent) died. The risk of repair in infancy was greatly increased. There were 5 late deaths, and reoperation was required in 11 patients. Sixty-eight per cent of the survivors are in New York Heart Association Class I and 29 per cent are in Class II. Some late complications related to deteriorations of the earlier aortic homograft conduit may be avoided by use of a Dacron conduit with a porcine valve, as suggested by short-term favorable results in 25 recent cases. The current operative mortality rate of 8 per cent (last 25 operations) and the observation that all but one of the late survivors in this series are either asymptomatic or only mildly symptomatic tend to verify the Rastelli operation as the procedure of choice for repair of transposition of of the great arteries when associated with ventricular septal defect and pulmonary stenosis.

Abnormalities, Multiple↗
PubMed1976

Reconstruction of superior vena cava-right atrial continuity and "anatomic" repair of transposition of great arteries with ventricular septal defect.

A superior vena cava-to-right pulmonary artery anastomosis (Glenn procedure), used to palliate certain types of cyanotic congenital heart defects, has usually been left intact at the time of definitive intracardiac repair. Late failure of this shunt has prompted attempts to reestablish superior vena cava-to-right atrium and right ventricle-to-right pulmonary artery continuity. The present patient, a 10-year-old boy with transposition of the great arteries, ventricular septal defect, and mild pulmonic stenosis, had had a Glenn procedure performed at 3 years of age. Angiography demonstrated a patent superior vena cava-to-right pulmonary anastomosis. The appearance of the main left pulmonary artery and of its peripheral branches suggested the presence of pulmonary vascular obstructive disease in the left lung. Therefore, it was considered advisable to reconnect the right ventricle to the right pulmonary artery, which was "protected" by the long-standing low-pressure shunt. The operative result, the intraoperative hemodynamics, and the postoperative assessment of the pulmonary blood flow by means of lung scanning, which clearly demonstrated a preferential perfusion of the right lung, support the validity of this approach.

Arteriovenous Shunt, Surgical↗
PubMed1976

Pulmonary infarction following ligation of terminally shunted pulmonary artery.

The intracardiac repair of tetralogy of Fallot occasionally is complicated by the presence of a surgically created shunt between a systemic artery and the distal end of a divided pulmonary artery. Rarely, reconstruction of this pulmonary artery at the time of corrective operation is not technically feasible. Usually, this problem has been managed by obliterating the systemic-to-pulmonary arterial shunt, which has not previously been reported to result in complications in the involved lung. Two of our patients underwent intracardiac repair of tetralogy of Fallot, including ligation of a terminally shunted left pulmonary artery. Postoperatively they developed infarction of the left lung with resulting acute respiratory insufficiency. In both instances, conservative management ultimately achieved resolution of the pathological process and a good clinical result.

Adult↗
PubMed1976

Complete repair of transposition of the great arteries with pulmonary atresia.

In this series of 13 patients undergoing repair of transposition of the great arteries with ventricular septal defect and pulmonary atresia, the operative risk and postoperative complications were greater than for repair of either transposition of the great arteries with ventricular septal defect and pulmonary stenosis or pulmonary arterial atresia with ventricular defect. Nevertheless, 6 of the 8 survivors improved clinically. Because operative and late mortality and morbidity rates are related to persistent right ventricular hypertension caused primarily by restricted pulmonary arterial outflow, results should be improved by performance of a preliminary systemic-pulmonary artery shunt for patients with hypoplastic pulmonary arteries and by use of the Hancock prosthesis, which has yielded lower gradients at both the proximal and distal anastomoses of the conduit. These improvements and the relief from cyanosis, exercise intolerance, and other symptoms seem to justify the continued application of surgical correction of transposition of the great arteries when associated with pulmonary atresia.

Adolescent↗
PubMedDate not supplied

Abdominal aorta-caval fistula: treatment with aortic and caval synthetic grafts (one year follow-up).

A fistula located between the abdominal aorta and the inferior vena cava is an unusual acquired condition which necessitates prompt diagnosis and, in most instances, emergency surgical repair. The signs and symptoms are related to the size of the shunt. The classical findings are those of a continuous abdominal bruit, edema and venous pooling of the legs, wide pulse pressure, and sudden progressive high-output cardiac failure. Aortography is the definitive diagnostic procedure. However it is impractical in those situations presenting an asymptomatic fistula and contraindicated in presence of signs of progressive renal failure, where emergency surgical treatment is required. In these instances aorta-caval fistula can be correctly diagnosed by means of radionuclide aortography. The fistula can usually be repaired from within the aneurysm after endoarterectomy. Then the aortic graft replacement is completed. In rare cases the pathology at operation is such that this type of repair cannot be performed and an unexpected replacement of the inferior vena cava may be required. The purpose of this paper is to present the description of a patient in whom the diagnosis of aorta-caval fistula was confirmed by means of an isotope angiogram, followed by a successful surgical graft replacement of the abdominal aorta and a dacron tubular graft replacement of the inferior vena cava.

Aged↗