Search PubMed⌕ Search

Biomedical subjects

C Santoli

Publications and source records attributed to C Santoli.

At least 55 records · Page 3Linked to original sources
PubMed1991

Posterior pericardial annuloplasty: a physicological correction?

Since the introduction of the annuloplasty ring, many attempts have been made to obtain a flexible ring that preserves the physiological motion of the mitral annulus. We experimented with a new technique using autologous pericardium to construct a more flexible ring. Twenty patients underwent mitral valve repair for degenerative disease and were treated by a posterior pericardial annuloplasty and the usual valvuloplasty procedures. A long strip of pericardium was prepared, marked with metal clips and rolled up in a tubular fashion with the serosal surface on the outside. The pericardial tube was apposed on the posterior annulus just beyond the commissures. No patient required early or late reoperation. Doppler analysis showed good valve function: 18 patients had no or mild, and 2 had moderate regurgitation. Transmitral flow indexes were nearly normal (MVA = 3.7 +/- 0.4 cm2; flow velocity peak = 1.06 +/- 0.2 m/s). Fluoroscopic examination was employed for assessing annular motion using the metal clips as radiopaque markers. Planimetry of the hemiarea showed a mild narrowing (mean 8.5% +/- 6.4%) of annular size during ventricular systole. There was a trend toward a systolic reduction of the anteroposterior diameter of the annulus. These findings demonstrate that the mitral orifice preserves its flexible properties after this type of annuloplasty. Posterior pericardial annuloplasty seems to be a physiological correction of annular dilatation in patients with degenerative disease.

Adult↗
PubMed1991

Technical progress in coronary surgery.

This report reviews the most recent technical advances that improve the results of coronary artery bypass grafting and discusses advantages and limitations in revascularization by extensive employment of arterial grafts. There is evidence that the use of the second internal mammary artery for coronary grafting, in selected cases, gives excellent long-term results. The use of alternative arterial conduits in conjunction with both internal mammary arteries in order to achieve complete revascularization with arterial grafts only has yielded good short-term results. However, for late results further and larger studies are necessary. In diffuse coronary artery disease, complex vessel endarterectomy and reconstruction procedures are currently performed by several surgeons with low operative risk and good midterm clinical results. Favorable results concerning the patency of the endarterectomized coronary arteries and related grafts have been reported.

Coronary Artery Bypass↗
PubMed1991

Tracheal obstruction due to congenital tracheomalacia in a child. Case report.

Congenital tracheal obstruction, though not notably uncommon in infancy, is rarely due to isolated tracheomalacia, especially when characterized by complete absence of cartilaginous rings. A 5-year-old boy underwent successful tracheal resection and anastomosis following severe tracheal obstruction due to aplasia of cartilaginous rings.

Child, Preschool↗
PubMed1991

[Myocardial revascularization with arterial grafts alone: our experience].

Bilateral internal mammary artery (IMA) grafting is recognized as a preferred method of myocardial revascularization. However, for multivessel coronary artery disease, saphenous veins often have to be added to complete myocardial revascularization. The right gastroepiploic artery (rGEA) has been recently recognized as a suitable arterial conduit to obtain with both IMAs a complete myocardial revascularization without conventional vein graft. From December 1985 to July 1990, 87 selected patients underwent coronary artery bypass grafting using only the two IMAs and, from December 1988, the rGEA. There were a total of 220 coronary artery bypass grafts (mean 3.06/patient) and 267 coronary artery anastomoses (mean 1.21 anastomoses graft). There was one perioperative death (1.14%), 3 patients (3.5%) developed a perioperative myocardial infarction, and 7 patients (8.04%) needed a transitory inotropic pharmacological support. Two patients (2.29%) underwent reoperation for bleeding, and a third (1.14%) for sternal diastase. Fifty-five patients (63.2%) underwent postoperative angiography: 6/139 grafts (4.31%) (3 rGEA free, 2 rIMA free, 1 rIMA in situ) were occluded. After follow-up, ranging from 12 to 66 months (30.54 average), 77 patients (92.77%) were free from angina, one patient underwent reoperation 7 months later and a third died for sudden death 55 months after the operation. There were no gastric complications due to rGEA harvesting. Actually, bilateral IMA grafting is the best investment for the patient who needs myocardial revascularization. The rGEA is a promising conduit whose only concern could be the long-term patency; this will be resolved in the future. Up-to-date combined arterial graft utilizing the IMA and the rGEA can facilitate complete revascularization by arterial grafts safely and effectively.

Coronary Artery Bypass↗
PubMed1990

Isolated atresia of the left main coronary artery in an adult.

A 49-year-old woman with isolated atresia of the left main coronary artery is presented. The patient who suffered from angina underwent myocardial revascularization 14 years after the onset of symptoms. A left internal mammary artery to left anterior descending coronary artery bypass was performed. Twenty months after the operation, the patient is free from angina and leads a normal life. The clinical features, diagnosis and management of the left main coronary atresia in adults are discussed.

Angina Pectoris↗
PubMed1990

Gastroepiploic artery free graft for coronary bypass.

The internal mammary artery (IMA) is the graft of choice for CABG but has a limited number and length. For multivessel coronary disease, saphenous vein grafts have to be added but they show poorer long-term patency. Investigation to provide adjunctive reliable grafts has recently focussed on the right gastroepiploic artery (GEA) and encouraging results have been reported employing this vessel as a pedicled graft to bypass distal coronary vessels. From December 1988 to February 1989, to achieve complete myocardial revascularization with only arterial grafts we used a GEA free graft in combination with the two IMAs in 20 consecutive patients under 70 years of age undergoing elective surgery. Before starting, histological studies were carried out and a significant similarity between IMA and GEA was found. In the 20 patients, 76 coronary anastomoses were performed (3.8 bypasses/patient), the GEA graft revascularized the right coronary artery in 9 patients, the circumflex in 8 patients and the anterior descending and/or diagonal in 3 patients; in 7 patients the GEA graft was used for sequential anastomoses. No perioperative deaths, no myocardial infarctions and no gastroenterological complications occurred. Coronary angiographic postoperative control showed 20/20 patent GEA grafts. After follow-up ranging from 7 to 9 months, all patients are free from angina. The GEA free graft is not difficult to harvest, is easier than the pedicled GEA graft to handle in the pericardium and is suitable for sequential anastomoses. The use of GEA graft however increases the complexity of bypass operations.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1990

[Echo-Doppler study of myxomatous mitral valve insufficiency and the results of reparative surgery].

The aim of conservative management of mitral regurgitation caused by floppy mitral valve is to restore a valvular function which closely resembles that of normal physiology. Fifty-eight patients affected by floppy mitral valve underwent surgical procedures for severe mitral regurgitation due to chordal elongation and/or rupture. Of these, 28 presented posterior mitral prolapse corrected by quadrangular excision of the prolapsed part and posterior anuloplasty achieved by apposition of a polytetrafluoroethylene conduit. The remaining 30 patients presented anterior or bilateral prolapse corrected by transposition of chordae from the posterior leaflet to the anterior cusp together together with anuloplasty. A complete echo-Doppler study was performed preoperatively, 10 days after the operation and every 6 months thereafter. Mean follow-up was 16.1 +/- 6.3 months. Preoperatively, 44 patients presented severe mitral regurgitation and 14 had moderate regurgitation (quantified by means of pulsed Doppler). All patients showed severe enlargement of the left cavities (LVDD 67.1 +/- 8.6 mm, left atrium 53.4 +/- 10.9 mm) with normal mitral area (6.08 +/- 2.14 sqcm, Doppler measurement). Following surgery we found a significant reduction in: 1) the degree of mitral regurgitation (29 patients had no regurgitation; 20 had mild protosystolic mitral regurgitation (29 patients had no regurgitation; 20 had mild protosystolic mitral regurgition, confirmed by color-M-mode; moderate or severe regurgitation was found in 6 cases); 2) the left ventricle and left atrium dimensions (LVDD 53.4 +/- 5.2 mm, p less than 0.01; left atrium 43.8 +/- 11.1 mm, p less than 0.01). Color flow imaging provided information about the recovery of a normal valvular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography, Doppler↗
PubMed1989

[Cardiac echinococcosis: 2 cases treated surgically].

Cardiac hydatid disease represents 0.02-2% of the possible locations of the parasite. In these last few years we have seen an increase in the percentage of cardiac hydatid disease treated with surgery. The Authors report on two patients who underwent surgery for the excision of cardiac hydatid cysts. The Authors agree that in spite of the rarity of cardiac hydatid disease it should be investigated routinely by two-dimensional echocardiography in the presence of hepatic or pulmonary hydatid disease in order to prevent the possible spread of the parasite throughout the body.

Adolescent↗
PubMed1989

[Autologous blood transfusion in elective heart surgery: prospective study of 189 consecutive patients].

Blood autotransfusion has entered a new phase in blood transfusion technique, since it represents an important alternative in eliminating the risks connected with blood transfusion: viral hepatitis, AIDS, blood transfusion reactions, and alloimmunization. Transfusion requirements during cardiac surgical procedures have steadily decreased; nowadays most adult patients require no transfusion during surgery. Patients (pts) receiving bank-blood may develop infectious diseases (hepatitis, AIDS, etc.). We have studied how to avoid the risk of infections with homologous blood transfusions. We present our experience of day-hospital pre-operative autologous blood collection. One-hundred-eighty-nine patients undergoing primary myocardial revascularization or valvular replacement were submitted to the drainage of 350 ml of blood three times every four days before surgery. The blood was centrifuged at once, to separate red cells from plasma. Surgeries were performed 21 days after the first drainage; iron therapy was recommended. After surgery pts received blood only if haematocrit was lower than 28%. The following data were recorded: no. of pts who received homologous blood; blood loss and homologous total blood volume used for each pt. Average blood loss was 1230 cc for ischemic pts and 701 cc for valvular pts. Non-A non B hepatitis occurred in 3/189 pts (1.5%). All of them had received homologous blood transfusions. Our data show clearly that autotransfused pts had a better post-operative period; less bank-blood and fewer transfusions have been used. No pt had collateral effects such as angina or hypotension from blood drawing. Our data show that severe cardiac diseases do not represent an absolute contraindication to heavy blood drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion, Autologous↗
PubMed1988

[Myocardial revascularization using both internal mammary arteries. Clinical results and surgical strategy].

To improve the benefits from coronary artery grafting with internal mammary artery (IMA) several technical manoeuvres and methods have been developed to increase the number of coronary arteries and their branches that can be bypassed with internal mammary arteries. Between November 1985 and December 1986, 50 patients underwent a surgical myocardial revascularization procedure using both internal mammary arteries by single or sequential anastomoses and supplemental saphenous vein graft. In 42% of these patients complete revascularization was achieved employing only internal mammary artery grafts. One hundred and twenty-six internal mammary artery grafts (77% of the total coronary bypass performed), were placed. One patient developed perioperative myocardial infarction. Reparative surgery to control immediate post-operative bleeding was required in two patients. Post-operative coronary angiography performed in 30 patients showed all patent internal mammary artery grafts but one. No late deaths occurred. Mean follow-up of 10 months was complete in 50 patients, of whom 94% are symptom free. We conclude that bilateral internal mammary artery grafting can be performed with low operative risk and can provide excellent long-term functional improvement and survival employing only high patency arterial conduit. Moreover, it doesn't significantly increase surgical morbidity.

Adult↗
PubMed1988

[Mitral insufficiency caused by floppy valve: results of conservative surgical treatment].

Between January 1986 and November 1987, 31 patients (pt.) underwent reconstructive surgery for mitral regurgitation secondary to floppy valve. Six pt. were in NYHA functional class IV, 22 in III class and 3 in II class. The mitral valve prolapse was posterior in 20 cases, anterior in 7 cases and bilateral in 4 cases. Chordal rupture was present in 18 pt. The mitral valve was repaired by quadrangular excision of the mural leaflet and posterior annuloplasty performed by insertion of polytetrafluoroethylene graft. The anterior prolapse was managed by transposition of chordae from the mural leaflet to the prolapsed part of the anterior leaflet (11 cases). One patient died perioperatively from myocardial infarction. Subsequent follow-up (length: 12.1 +/- 4.9 months) revealed good functional and clinical results: all pt. were alive, in NYHA class I or II (3 pt.). Echocardiographic studies revealed a decrease in diastolic (3.68 +/- 0.6 vs. 3.17 +/- 0.3 cm/m2) and systolic (2.4 +/- 0.5 vs. 2.15 +/- 0.4 cm/m2) diameter. The shortening fraction did not decline significantly. The mitral area fell from 6.0 +/- 2.0 cm2 to 3.1 +/- 1.1 cm2. A moderate residual regurgitation was present in two pt. and a severe regurgitation was found in only one pt. Our experience suggests that valve repair may be considered the most suitable type of operation for mitral regurgitation secondary to floppy valve.

Aged↗
PubMed1987

Coronary endarterectomy combined with vein patch reconstruction and internal mammary artery grafting: experience with 18 patients.

Over a 19-month period (from November 1985 to June 1987), 18 patients underwent open coronary endarterectomy combined with vein patch reconstruction and internal mammary artery (IMA) grafting. All 18 patients had disabling angina and severe, diffuse coronary atherosclerosis that prevented revascularization by conventional means. Thirteen underwent open endarterectomy of the left anterior descending coronary artery, and the remaining five had open endarterectomy of the right coronary artery. All patients received additional bypass grafts to other coronary arteries (2.6 grafts per patient). There was no operative mortality, but one patient had a perioperative myocardial infarction that was unrelated to the open endarterectomy. Postoperative angiography in 16 cases showed that only one of the grafts to the endarterectomized artery was occluded. After a mean follow-up of 8.7 months, all the patients but one were angina-free. No late deaths occurred. Although the long-term clinical results and graft patency have yet to be evaluated, the early results of this series encourage us to continue using this technique in patients whose diffuse coronary artery disease is untreatable by conventional means.

Journal Article↗