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Biomedical subjects

C Santoli

Publications and source records attributed to C Santoli.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Coronary endarterectomy (blind and open) associated with bypass. Experience in 143 patients].

From June 1982 until January 1986, 173 coronary endarterectomies (EA) with bypass were performed in 143 patients. The series includes 130 conventional EA and 43 open EA with coronary reconstruction. In 9 cases of open EA the revascularization of the reconstructed coronaries was accomplished with internal mammary artery (AMI). 70 (40.4%) EA were performed on the right coronary artery, 75 (43.3%) on the left anterior descending coronary artery and 28 (20.1%) on the left circumflex coronary artery. The early mortality rate in the entire group was 3.5% (respectively 2.0% for the conventional EA and 7.3% for the open EA) and the rate of perioperative myocardial infarction was 8.4% (7.8% in patients receiving conventional EA and 9.7% in those receiving open EA). With mean follow-up of 18.4 months, most (89.8%) of the surviving patients were either symptoms-free or greatly improved. Coronary endarterectomy is a worth-while procedure and it allows surgical management of otherwise inoperables arteries.

Adult↗
PubMed1986

Continuous recording of direct high fidelity arterial pressure and electrocardiogram in ambulant patients.

A system providing high quality direct arterial blood pressure recordings and electrocardiograms in ambulatory patients was devised using a modified commercially available Holter type magnetic tape recorder together with a microminiature Millar (3F) tip transducer. This system did not require a perfusion line and solved the major drawbacks of other available systems. Pressure and electrocardiographic data were fed directly from the playback unit into a minicomputer for automatic beat to beat waveform analysis. Thus the blood pressure and RR interval variability signals could be simultaneously analysed with autoregressive modelling techniques to provide a quantitative estimate of sympathovagal balance in ambulant patients. The system was reliable, simple, and safe to use.

Ambulatory Care↗
PubMed1986

Alterations in norepinephrine content and beta adrenoceptor regulation in myocardium bordering aneurysm in human heart: their possible role in the genesis of ventricular tachycardia.

On the assumption that alterations in the adrenergic system may play a role in generating ventricular tachycardia in patients with myocardial post-infarction apical aneurysm, we evaluated norepinephrine concentration, number and affinity of both beta 1 and beta 2 adrenoceptors in perianeurysmatic tissue in twelve patients operated upon for congestive heart failure and recurrent sustained ventricular tachycardia. Concentration of norepinephrine in perianeurysmatic tissue was 0.1 +/- 0.05 micrograms g-1 tissue (n = 8), this value being much lower than that found in papillary muscle (n = 10) from patients with mitral valve stenosis (0.8 +/- 0.02 micrograms g-1 tissue) (P less than 0.01). The total number of beta adrenoceptors (71.4 +/- 7.8 v. 48.0 +/- 5.1 fmol mg-1 protein; P less than 0.01) and the percentage of beta 1 subtype were found to be higher in perianeurysmatic tissue (approximately 90%) than in papillary muscle (approximately 68%). Out of twelve patients with aneurysm, beta 2 adrenoceptors had considerably decreased in three patients and were absent in the remaining nine. Decrease in the neuronally released norepinephrine associated with contrasting behaviours of beta 1 and beta 2 adrenoceptors suggests the presence of a profound alteration in the sympathetic innervation of the perianeurysmatic myocardial tissue that may contribute to the genesis of sustained ventricular tachycardia in patients with postinfarction apical aneurysm.

Adult↗
PubMed1986

[Coronary endarterectomy: state of the art].

Coronary endarterectomy (EA) allows to recanalize and bypass what appear to be an otherwise inoperable vessel. Although the application of this procedure is still controversial, there is now an increasing tendency to use the EA more frequently and recent studies confirm this trend. A variety of individualized techniques of performing coronary EA (local EA, conventional "blind" EA, open EA with coronary reconstruction, laser EA) are analyzed. Technical aspects, indications and results (operative risk, symptomatic improvement, grafts patency) of each procedure are evaluated on the basis of the current experiences. Although hospital mortality and perioperative infarction rates are moderately higher than in routine grafting, it is stressed that EA is a valuable supplement to coronary artery bypass grafting extending the indications of myocardial revascularization: a) larger number of conventionally inoperable patients can benefit from the surgical treatment; b) more complete revascularizations are possible in patients with diffuse coronary disease.

Coronary Artery Bypass↗
PubMed1986

[Contrast echocardiography in the diagnosis of tricuspid insufficiency. Evaluation before and after cardiosurgical intervention in 24 patients].

26 patients (pts) (8 males and 18 females), mean age 50 +/- 9 years, with rheumatic valve (MV) disease, candidates to MV replacement, were examined by contrast echocardiography (CE) before and after surgery. This was done in order to assess pre and postoperatively the presence of associated tricuspid regurgitation (TR) and to evaluate the short and long-term results of the operation on the TR itself. For assessing TR, the systolic presence, intensity and persistence of the microbubbles of the contrast medium injected into an antecubital vein, were observed within the inferior vena cava (IVC). We used synchronous time motion (TM) and two dimensional (2D) echocardiography from subcostal view. TR was classified as follows: severe (massive systolic opacification and persistence of the microbubbles in the IVC for at least 20 seconds); moderate (moderate systolic opacification lasting less than 20 seconds); mild (slight systolic opacification lasting less than 10 seconds); insignificant TR (sporadic appearance of the contrast medium into the IVC). On the average, the examination was carried out 48 hours before surgery, 15 days after and, in pts undergoing De Vega tricuspid valvuloplasty, 14 months after the operation. At pre-operative examination, massive TR was found in 16 pts, only 6 of whom showed clinical signs of TR. The findings were confirmed at surgery in 15 pts who underwent not only MV replacement but also tricuspid repair. In the other pts, agreement was found between CE and surgery as far as moderate TR was concerned, meanwhile mild CE TR was not confirmed at surgery. Sensitivity (SN) was 100%, specificity (SP) 38%, positive predictive value (PPV) 78%, negative predictive value (NPV) 100%. Excluding CE mild TR, SP and PPV raised to 75% and 95% respectively, meanwhile SN and NPV remained 100%. Short term post-operative follow-up CE performed on 13 out of the 15 pts with tricuspid repair showed no signs of TR in 7 and slight signs in 6. Furthermore, in those pts undergoing simple MV replacement, CE showed a marked reduction of the contrast echographic effect. Long term post-operative follow-up CE performed in the 13 pts with tricuspid repair showed no signs of TR in 9, slight signs in 3. Moreover in two pts massive TR due to late mitral prosthesis detachment was diagnosed by means of CE and confirmed at cardiac catheterization and surgery.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1985

Fibrin adhesive: clinical application in coronary artery bypass graft surgery.

Fibrin adhesive was used 72 times in a group of 67 patients undergoing elective coronary artery bypass graft surgery. The indications were prophylactic sealing of potential sources of bleeding, topical hemostasis (control of bleeding sites dangerous or difficult to suture), and fixation of the graft in the optimal position. The method of glue application under varying circumstances is described and the results are reported. This experience suggests that in some cases the glue expedites the operation and makes it safer. We conclude that the fibrin sealing represents a valid aid in coronary artery bypass graft surgery.

Journal Article↗
PubMed1985

[Myocardial protection in valvular surgery by retroperfusion of the coronary sinus with cardioplegic solution in valve surgery. Immediate results and technical considerations].

Retrograde coronary sinus perfusion as a means of delivering cardioplegia was evaluated in 20 patients undergoing cardiac valve surgery. Other 10 patients, undergoing similar operation with antegrade coronary cardioplegic perfusion served as a control. Results showed no significant differences between the two groups of patients in terms of: myocardial cooling; pre-ischemic and post-perfusion myocardial lactate extraction; post-operative clinical findings (myocardial infarction occurrence, need for inotropic support, mortality). We conclude that retroperfusion through the coronary sinus is a safe and effective alternative of cardioplegic delivery. Since it simplifies the operative procedure (it allows the cardioplegia delivery at any desired time of the operation, without discontinuing the procedure), we recommended its use during valvular cardiac operations, especially on aortic valve replacement.

Heart Arrest, Induced↗
PubMed1984

Massive coronary gas embolism managed by retrograde coronary sinus perfusion.

A case of massive coronary air embolism occurred during cardiopulmonary bypass because the rotation of the pump suction line, which was connected to the aortic root vent needle, was mistakenly reversed. An embolism injured the heart and caused severe functional impairment. After completion of the procedure (double vein bypass graft), the patient could not be disconnected from bypass. However, successful management with temporary retrograde coronary sinus perfusion was quickly achieved.

Journal Article↗
PubMed1984

[Obstruction of the superior vena cava caused by sclerosing mediastinitis. Surgical treatment by bypass with a composite spiral venous graft].

A 68-year-old woman with obstruction of the superior vena cava due to sclerosing mediastinitis was successfully operated on. A composite spiral vein graft was interposed between the left innominate vein and the right atrium to bypass the occluded superior vena cava. The graft was made using the patient's own saphenous vein, which was divided longitudinally and sutured around a cannula in a spiral fashion. Indications to surgical intervention in patients with superior vena cava syndrome are discussed.

Aged↗
PubMed1982

[Stenosis of the left coronary trunk. Results of aorto-coronary bypass in a series of 46 patients].

Forty-six patients were operated on from 1979 to 1980 in the Department of Cardiovascular Surgery "A. De Gasperis" in Milan, to relieve left main coronary artery stenosis. There was only one death (2,1%) in a patient with "untractable angina". Three patients had per-operative infarction. No other complication were noted. The follow-up varies from 4 to 30 months: 40 patients are asymptomatic, 2 are improved, 1 patient had a recurrence of angina after 15 months. There were no deaths nor myocardial infarctions in the long-term follow-up.

Adult↗
PubMed1981

[Chronic mitral insufficiency secondary to coronary arteriosclerotic cardiopathy. Results of surgical treatment in 16 cases].

Our experience with 16 patients operated upon for chronic mitral insufficiency secondary to coronary artery disease is reported. The patients ranged from 40 to 65 years in age; all were in class III or IV of the N.Y.H.A. classification (10 in class IV), 3 were resuscitated from ventricular fibrillation and 11 had a cardiac index less than 2.2 1/min/m2. 15 patients had replacement of the mitral valve with a mechanical or biological prosthesis and 1 had mitral valve repair. 11 of the 16 patients also underwent aorocoronary bypass procedures. There were 2 deaths within the first 30 days following the operation (operative mortality 12.5%) and 6 more deaths during the follow-up period. 6 patients died of heart failure, correlated in 3 cases with extremely severe impairment of left ventricular function (wall motion abnormalities in all segments of the ventriculographic perimeter). Death was sudden in 2 cases. In the 8 surviving patients the clinical result is good. Preoperative factors affecting post-operative prognosis are investigated and guidelines of the indications for the surgical treatment are discussed.

Adult↗
PubMed1981

[Post-infarction aneurysm of the left ventricle. Pre-operative parameters conditioning the surgical risk and remote results].

83 patients who underwent resection of postinfarction aneurysms involving the anterior wall of the left ventricle were studied to identify possible determinants of operative outcome, long-term survival and long-term improvement. The indications for aneurysmectomy (either isolated or combined with direct revascularization) were congestive heart failure, angina or life-threatening arrhythmias; six patients were asymptomatic at the time of surgery. Operative mortality rate was 14.4% (11.5% for patients operated more than 60 days following myocardial infarction). The over-all survival rate, at a mean follow-up of 31.5 months (range 2 to 82 months), was 74.39%; 80.88% of patient discharged from hospital, exhibited clinical improvement. Mean values of ejection fraction and excess ejection fraction were significantly higher in the group of operative survivors (31.28 +/- 8.26% and 0.17 +/- 0.08 respectively) than those of surgical deaths (20.25 +/- 8.37% and 0.08 +/- 0.06) (p less than 0.005); the coronary score was significantly lower in the group of survivors (6.81 +/- 2.35 vs 8.33 +/- 2.29) (p less than 0.025). Presence of arrhythmias increased operative mortality (33.3% vs 11.2%, p = 0.05), as did a low cardiac output, impaired contraction of the postero-lateral wall and mitral regurgitation. Long-term survival and improvement were not related to anyone of preoperative parameters taken into consideration: however, a higher percentage of clinical improvement was observed when myocardial revascularization was associated to aneurysmectomy (85% vs. 67.7%).

Adult↗
PubMed1977

[Ventricular septal defect and valvular aortic insufficiency. Our experience with nineteen patients (author's transl)].

Nineteen patients with ventricular septal defect (V.S.D) and valvular aortic insufficiency (A.I.), who underwent surgical repair, were reported. In the majority of patients the V.S.D. was localized in the supracristal region and the most frequent aortic valve abnormality was a prolapsing right cusp. Closure of the V.S.D. was effected with a patch in 15 patients and by direct suture in 4. Surgical management of A.I. consisted of: a) replacement of the aortic valve in 12 patients; b) no procedure on the aortic valve in 6 patient; c) plastic repair of the aortic valve in 1 patient. Only one patient died. Conservative management of the A.I. is advocated, but this is possible only if early repair is attempted. In adults, replacement with a prosthesis is indicated for severe A.I.

Adolescent↗
PubMed1976

[On 23 cases of postinfartual interventricular septal rupture s].

Twenty-three patients with ventricular spetal rupture complicating acute myocardial infarction underwent surgical repair. In 15 patients the interval between occurrence of myocardial infarction and operation varied from 2 to 18 days and in 8, from 2 to 9 months. In the group of the patients operated on early after the myocardial infraction (less than three weeks) the hospital mortality was 60%; in the group of patients operated on later, the ospital mortality was 12%. Tir six patients had a cardiac catheterization which showed a decrease of the end diastolic left ventricular pressure and a decrease of the pulmonary pressure. In two patients a residual small left-to-right shunt was present. The Aentricular septum is surgical; B) the surgical closure of the rupture should be delayed when possible from three to six w-eks after the infarction; C) in the patients operated on early after the myocardial infarction the operative risk is high, but the long-term results are good, as they are in the patients operated on later after infarction.

Acute Disease↗