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Biomedical subjects

E Quaini

Publications and source records attributed to E Quaini.

At least 37 records · Page 2Linked to original sources
PubMed1994

End-stage cardiac failure in humans is coupled with the induction of proliferating cell nuclear antigen and nuclear mitotic division in ventricular myocytes.

Proliferating cell nuclear antigen (PCNA) is a late growth-regulated gene that is expressed at the G1-S boundary of the cell cycle and is required for DNA synthesis and cell proliferation. Since quantitative results suggest that myocyte hyperplasia occurs in the decompensated human heart, we postulated that induction of the PCNA gene may be present in the failing heart in humans. PCNA protein was detected in myocardial samples obtained from the left and right ventricles of patients with congestive heart failure. Endomyocardial biopsies collected from donor subjects were used as control tissue. The percentage of positively stained myocyte nuclei in the ventricles was established by using PCNA monoclonal antibody and the immunoperoxidase technique. The localization of PCNA in myocytes was confirmed by alpha-sarcomeric actin antibody staining. PCNA labeling was present in left ventricular myocytes of 29 of the 32 hearts examined. In the right ventricle, 24 of the 29 samples showed positive staining. In a subset of 25 patients, the percentage of PCNA-labeled myocyte nuclei was measured and found to constitute 49 +/- 22% of left ventricular myocytes. A similar analysis for the right ventricle, conducted in 21 patients, showed that 49 +/- 19% of the myocyte nuclei exhibited PCNA protein. In addition, mitotic figures in myocytes were documented. A quantitative analysis of this cellular process revealed that 11 myocyte nuclei per 1 million cells exhibited mitotic images in chronic heart failure. Immediately after myocardial infarction, two cells per million showed mitotic division, and this phenomenon was restricted to the region adjacent to the necrotic tissue. No PCNA labeling or nuclear mitotic images were detected in the ventricular myocardium of control subjects. Thus, the observation that diffuse PCNA labeling and myocyte mitotic division are present in hearts with end-stage failure strongly suggests that adult ventricular myocytes are not terminally differentiated cells and that myocyte cellular hyperplasia may constitute a growth reserve mechanism of the diseased heart.

Adult↗
PubMed1994

Extrathoracic ectopia cordis. Case report.

Extrathoracic ectopia cordis is a challenging congenital anomaly: surgical repair is generally unsuccessful because of the magnitude of the deformity and the associated intracardiac anomalies. Our clinical case had additional surgical risk for prematurity. Immediately after birth the mediastinal space was surgically enlarged and the naked heart covered with a prosthetic patch. Complete repair (placement of the heart inside the chest) would have been done later. The newborn infant survived the 1st procedure; unfortunately few hours later he died for not cardiac-related causes. Surgical strategies on this topic are discussed.

Adult↗
PubMed1994

[Aortic valve replacement in old age. The results and follow-up echo-Doppler study of the prostheses].

BACKGROUND: To analyze the results of aortic valve replacement in elderly patients and to evaluate the hemodynamic performance of valvular prostheses, we have retrospectively studied the patients 70 years of age or older, who consecutively underwent aortic valve replacement in our Center. METHODS: From January 1988 to December 1992, a series of 112 patients aged 70 to 88 years (mean 74.8 +/- 3.8 years) underwent aortic valve replacement; 49.1% of patients were male; aortic valvular lesion was: stenosis in 65.2%, insufficiency in 9.8% and mixed stenosis and insufficiency in 25.0%. In 73.2% isolated valve disease was present; in 25.0% coronary artery disease was associated. Preoperatively 58.9% were in New York Heart Association class III, and 29.5% were in class IV. Concomitant extracardiac diseases were present in 73.2%. The types of valve prostheses employed were: mechanical tilting disc (28 cases), mechanical bileaflet (40 cases), bioprosthesis (44 cases). A significantly favourable relationship between body surface area and size of prostheses was evident. RESULTS: Overall hospital mortality was 8.9% (5.4% for elective isolated aortic valve replacement) with significant difference (p = 0.006) related to criteria for surgical indication (elective 6.4%, urgent 10.0%, emergency 37.5%). Valvular lesion, age, sex, associated coronary artery bypass surgery, the values of peak and mean aortic valve gradient, the relative wall thickness and the presence of extracardiac disease have not been identified as risk factors for hospital mortality. The mean follow-up of the 102 discharged patients is 27.1 +/- 16.5 months (range 2 to 64 months). Eight late deaths (7.8%) occurred; the overall actuarial freedom from all deaths (excluding hospital mortality) was 95.6 +/- 2.2% at 1 year and 88.6 +/- 4.0% at 3 and 5 years. Five non fatal valve related complications occurred: hemorrhage in 4 cases (1.8% pt/yr) and hemolysis in 1 case (0.4% pt/yr). Ninety-seven percent of patients were found to be in NYHA functional class I or II. Comparative echocardiographic evaluation of the prostheses showed significant differences in mean gradient: regarding 21 mm size lower in bileaflet than in tilting disc and regarding 23 mm size lower in bileaflet than in tilting disc or bioprostheses. CONCLUSIONS: Aortic valve replacement has proved to be safe and effective in the elderly population and is considered the procedure of choice for aortic valve disease. Although we consider mandatory to choose the valve substitute matching different physiopathological and psychological attitudes of individual patient, mechanical prostheses and particularly bileaflet type for size < or = 21 mm should be preferred.

Aged↗
PubMed1993

Posterior annuloplasty in the surgical treatment of mitral insufficiency.

One hundred and twenty-nine patients underwent posterior mitral annuloplasty with a Gore-Tex tube for mitral regurgitation between January 1982 and June 1991. The hospital mortality was 1.5% (CL = 0.5%-2.5%). The overall survival of hospital survivors was 96.5% +/- 2.7% at five and 86.2% +/- 7.6% at nine years, freedom from cardiac death was 99.1% +/- 0.9% and 95.2% +/- 3.9%, respectively. The actuarial freedom from embolism was 96.1% +/- 2.3% at five and 88.5% +/- 5.5% at nine years. The freedom from endocarditis (one patient) was 100% and 92.6 +/- 7.1%, respectively. Reoperation was necessary in six cases between one and 72 months after the operation (mean 38.5 +/- 30.5 months). The etiology of the valvular insufficiency was rheumatic in all reoperated cases. The freedom from reoperation was 94.1% +/- 3.2% at five and 87.2% +/- 5.6% at nine years. There was no mortality at reoperation. Of the 117 patients alive at the end of follow up and not requiring reintervention, 113 (96.6%) showed good functional improvement and were in NYHA functional class I or II. We conclude that both the immediate and long-term results of reconstructive surgery using the technique of inserting a half-ring on the posterior mitral annulus compare favorably with those obtained using other annuloplasty methods.

Actuarial Analysis↗
PubMed1992

Evaluation and treatment of secondary tricuspid insufficiency.

To define the role of functional tricuspid insufficiency and right ventricular (RV) failure in patients with mitral disease, the data of 121 patients with secondary tricuspid insufficiency that underwent mitral valve replacement (MVR) from January 1982 to December 1987 were analyzed. The mitral hemodynamic lesion was: stenosis in 41 patients (33.9%); insufficiency in 11 (9.1%) and mixed stenosis and insufficiency in 69 (57.0%). NYHA functional class was: II in 4 patients (3.3%), III in 78 (64.5%) and IV in 39 (32.2%). In 100 cases (group 1) with tricuspid insufficiency defined as moderate or severe, a De Vega annuloplasty was performed while in 21 (group 2) with mild tricuspid insufficiency, no tricuspid surgical procedure was performed. Hospital deaths occurred in 17 of 121 patients [14% (CL 10.8-17.0)]. There was no significant difference in hospital mortality between group 1 and group 2 (15% vs 9.5%; P = 0.75). Incremental risk factors for hospital mortality as determined by multivariate analysis, include: cardiothoracic ratio (P = 0.0016), total aortic cross-clamp time (P = 0.006), associated cardiac disease (P = 0.0209) and emergency operations (P = 0.0318). Mean follow-up of surviving patients was 50.1 +/- 28.1 months. Late deaths occurred in 16 patients [15.4% (CL 11.7-18.7)]. The actuarial survival rate was 85.6% and 73.8% at 5 and 9 years, respectively. Nine patients [8.6% (CL 5.9-11.3)] required reoperation. There was no significant difference between group 1 and group 2 in the rate of late cardiac related deaths (5.9% vs 5.3%, P = 0.66) and of tricuspid reoperations (4.7% vs 5.3%, P = 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Repeat myocardial revascularization].

Eighty-two consecutive patients undergoing reoperation for coronary revascularization from January 1980 to November 1990 were reviewed to determine early and late results and predictors of survival. Seventy patients were male and 12 female; age ranged from 36 to 75 years (mean 56.4 +/- 8.1). All were symptomatic for angina. The mean interval between first and second operation was 62.8 +/- 47.8 months (range 1 to 220 months). Angiographic indications for reoperation were: graft failure (34.1%), progression of atherosclerosis in the native coronary circulation (6.1%) and combination of the two (59.8%). Mean ejection fraction was 45.9 +/- 10.2 (range 11 to 67). Surgical indication was elective in 79.3%, urgent in 14.6% and emergent in 6.1%; 199 grafts were performed (2.4 +/- 1 grafts/patient). Hospital mortality was 6.1% (5 cases). Late mortality was 5.2% (4 cases). Actuarial survival rate (including hospital mortality) was 87.9% at 3, 5 and 10 years. Multivariate analysis identified left main stenosis (p = 0.00001), family history of coronary disease (p = 0.003), urgent/emergency operation (p = 0.015) as predictors of increased in-hospital mortality; postoperative myocardial infarction (p = 0.002) and preoperative heart failure (p = 0.01) as predictors of increased late mortality. Follow-up of in-hospital survivors (mean interval 42.7 +/- 25.8 months, range 3 to 120 months) documented 27 cardiac major events (other than death) in 24 patients (32.9%). Actuarial rates of freedom from major cardiac events were 70%, 52.9% and 48.1% at 3, 5 and 10 years respectively. Multivariate analysis identified preoperative ejection fraction (p = 0.01) as predictor of recurrence of angina and preoperative heart failure (p = 0.02) as predictor of occurrence of cardiac major events.

Adult↗
PubMed1992

[Surgical revascularization in acute myocardial infarct].

To determine the potential role of emergency surgical revascularization as treatment of acute myocardial infarction (AMI), results in 79 patients undergoing operation for myocardial revascularization during AMI from January 1986 to January 1991 were reviewed. Clinical characteristics for inclusion in the study were: 1) emergency operation; 2) persistent angina not controlled by medical therapy; 3) fixed ST segment elevation until surgical procedure, independently from magnitude of enzymatic levels. The 79 patients were divided in 2 groups: 27 with AMI or evolving AMI (Group 1); 52 with AMI due to complications during PTCA (Group 2). Twenty-eight patients had extremely severe clinical conditions. Mean interval between the beginning of AMI and operation was 4.2 +/- 6.7 hours, with a statistically significant difference between Group 1 (8.7 +/- 10.0) and Group 2 (1.9 +/- 1.0). One hundred ninety-two grafts were performed (2.4 +/- 1.1 grafts/patient). Overall hospital mortality was 10.1% (CL 6.7-13.3) (8 deaths) with a difference between Group 1 [18.5% (CL 10.7-25.3)] and Group 2 [5.8% (CL 4.7-6.6)] (p = 0.074). The incidence of perioperative myocardial infarction was 30.4% (CL 24.9-35.1) for that one in the area of ischemic muscle and 2.6% (CL 0.8-4.1) for infarction in remote muscle. Multivariate analysis for the entire series (79 patients) identified as independent predictors of increased in-hospital mortality: preoperative cardiogenic shock (p = 1.000E-4) and hyperlipidemia (p = 0.008). In Group 1 multivariate analysis identified as independent predictors of increased in-hospital mortality: the attempt of revascularization by PTCA and hyperlipidemia; in Group 2: preoperative need of mechanical ventilatory support.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMed1991

Mitral valve replacement with the SORIN valve. Long-term follow-up of 1,161 patients.

From 1 March 1977 through 31 December 1987, 1,252 patients underwent mitral valve replacement with a SORIN-Biomedica 60 degrees tilting-disc prosthesis at our institution. Hospital mortality was 7.3% (91 patients); prosthesis-related deaths, expressed as a percentage of hospital mortality, accounted for 12.1% of these early deaths. The 1,161 patients who survived hospitalization have been followed up for a total of 4,835 patient-years (range, 1 to 128 months; mean, 50.4 +/- 27.3 months). Forty-three (3.7%) of these patients were lost to follow-up. The late mortality was 6.3% (1.5% +/- 0.2% per patient-year), and the 10-year actuarial survival rate, excluding hospital mortality, was 89.1% +/- 1.6%. The 10-year actuarial (and linearized) rates of freedom from valve-related complications were as follows: embolism, 94.4% +/- 1.0% (0.93% +/- 0.1% per patient-year); thrombosis of the prosthesis, 99.8% +/- 0.1% (0.06% +/- 0.03% per patient-year; hemorrhage, 93.7% +/- 1.5% (0.95% +/- 0.1% per patient-year); prosthetic valve endocarditis, 99.3% +/- 0.3% (0.14% +/- 0.05% per patient-year); reoperation, 90.6% +/- 2.1% (1.1% +/- 0.2% per patient-year); and overall complications, 76.6% +/- 2.5% (2.9% +/- 0.2% per patient-year). No structural deterioration was noted. These data not only confirm our previous reports concerning the reliability and durability of the SORIN prosthesis but also reveal a significant reduction, over the long term, in the overall incidence of valve-related complications.

Journal Article↗
PubMed1990

Usefulness of color Doppler in the diagnosis of ventricular septal rupture after myocardial infarction.

Ten consecutive patients with ventricular septal rupture complicating acute myocardial infarction were studied by means of Doppler echocardiography (including two-dimensional, conventional and color Doppler techniques) and bedside right heart catheterization using a Swan-Ganz catheter. One patient died before an operation could be performed. Seven critically ill patients underwent emergency cardiac surgery without preoperative cardiac catheterization, while in two patients it was also possible to undertake coronary angiography before surgery. Two-dimensional echocardiography diagnosed post-infarction ventricular septal rupture in 6 out of 10 patients. Color Doppler revealed the presence and the location of septal rupture in all 10 patients. The color Doppler diagnosis was confirmed either by surgery or necropsy. The estimates of pulmonary artery pressure, obtained by color Doppler-guided continuous wave Doppler beam, were very close to those measured by simultaneous right heart catheterization. In 3 patients, patch leakage occurred 3 days, 15 days and 1 year after the operation. Two-dimensional echocardiography revealed the patch leakage in only one of 3 patients while its location was visualized by color Doppler in all 3 patients. In one patient the color Doppler diagnosis was confirmed at necropsy. In the remaining 2 patients, a small left-to-right shunt was demonstrated by radionuclide studies. Color Doppler echocardiography is a highly sensitive and rapid technique in the diagnosis of postinfarction ventricular septal rupture. In critically ill patients it offers relevant information and may obviate the need for any invasive preoperate investigation.

Aged↗
PubMed1988

Synchronous brain metastasis from lung cancer. Result of surgical treatment in combined resection.

The results of combined surgical resection of brain metastasis and primary lung cancer from January 1976 to April 1986 were evaluated. In all cases the brain metastasis was single and synchronous and was resected first. There were 20 men and one woman, with an average age of 53 years. All patients initially had neurologic symptoms related to an intracranial mass. In 19 patients the primary lung cancer was roentgenologically visible, but in two the lesion was recognizable only by bronchoscopy. There were no operative deaths. Nine of 21 patients had a poor postoperative course and died during the first 6 months. The combined surgical approach improved the short-term survival rate in four patients, who died 11, 12, 18, and 21 months after the thoracic operation. In six patients (28.5%) survival for more than 2 years was obtained (three died after 27, 30, and 40 months, three are alive after 25, 28, and 48 months). Two others patients are alive and well 4 and 16 months after the thoracic operation. Synchronous onset of brain metastasis from lung cancer does not necessarily contraindicate combined operations, which can provide long-term survival in selected patients. The absence of mediastinal node metastasis is a favorable prognostic factor. Computed tomographic screening of the brain improves patient selection.

Adenocarcinoma↗
PubMed1987

Results of heart valve replacement with the SORIN prosthesis.

From March 1977 to December 1981, 872 patients at our institution underwent valve replacement with a pyrolytic carbon tilting disc prosthesis manufactured in Italy by SORIN-Biomedica. To verify the performance characteristics of this prosthesis, we analyzed the intermediate-term results obtained over a cumulative total of 3,041 patient-years (pt-yr) of follow-up. Three hundred sixty-nine patients underwent mitral valve replacement (MVR), 309 had aortic valve replacement (AVR), and 194 had both mitral and aortic (double) valve replacement (DVR). Expressed in actuarial terms (% [+/- standard error of the mean] free of adverse events at 5 years) and in linearized terms (% pt-yr), respectively, valve-related complications occurred at the following rates: Thromboembolism, 89.9 +/- 1.9% and 2.1 +/- 0.4% pt-yr (MVR); 92.1 +/- 1.9% and 1.7 +/- 0.4% (AVR); 90.5 +/- 5.0% and 2.2 +/- 0.6% (DVR). Anticoagulant-related hemorrhage, 95.2 +/- 1.5% and 1.4 +/- 0.3% (MVR); 95.9 +/- 1.5% and 1.3 +/- 0.3% (AVR); 96.0 +/- 2.0% and 0.9 +/- 0.4% (DVR). Prosthetic valve endocarditis, 99.0 +/- 0.6% and 0.2 +/- 0.1% (MVR); 97.4 +/- 1.0% and 0.6 +/- 0.2% (AVR); 94.5 +/- 1.7% and 1.4 +/- 0.4% (DVR). Reoperation, 92.6 +/- 1.5% and 1.7 +/- 0.3% (MVR); 89.4 +/- 1.9% and 2.4 +/- 0.4% (AVR); 82.3 +/- 2.9% and 4.8 +/- 0.8% (DVR). The total valve-related morbidity and mortality was 79.6 +/- 2.6% and 4.9 +/- 0.6% (MVR); 79.7 +/- 2.6% and 5.1 +/- 0.6% (AVR); 70.5 +/- 4.0% and 7.7 +/- 1.1% (DVR). The 5-year actuarial survival rate without hospital mortality was 86.8 +/- 2.0% (MVR), 91.0 +/- 1.7% (AVR), and 78.8 +/- 3.7% (DVR). The intermediate-term survival and complication rates showed the performance of the SORIN prosthesis to be quite satisfactory.

Journal Article↗
PubMed1986

Combined open-heart valve surgery and elective abdominal operations.

From January 1970 to December 1984, at the "A. De Gasperis" Division of cardiac surgery in 73 patients an open-heart valvular operation and an elective abdominal surgical procedure were simultaneously performed. Abdominal surgery was indicated for: cholelithiasis (41 cases), hernia (22 cases), uterine fibroleiomyomas (7 cases), pregnancy (1 case), marginal ulcer after gastric resection (1 case), association of cholelithiasis and hernia (1 case). The etiology of valvular disease was: previous rheumatic fever (69 cases) and acute bacterial endocarditis (1 case); there were 3 cases of periprosthetic leak. All patients were classified in NYHA class III or IV. In all patients the abdominal procedure was carried out first. No significant differences were noted between this group of patients and patients with isolated open-heart operations regarding: postoperative bleeding, stay in Postoperative Intensive Care Unit, overall postoperative hospital stay. There were 5 hospital deaths, all related to cardiac causes. There were no infectious complications, nor early or late abdominal wound complications. The rationale for the combined approach to abdominal and cardiac diseases includes: risk of non cardiac surgery in patients with critical heart disease, risk of non cardiac surgery in patients with previous cardiac valve operations and anticoagulant therapy and risk of abdominal complications after cardiopulmonary bypass surgery. Simultaneous abdominal and cardiac surgery is suggested on clinical, psychological and social grounds.

Abdomen↗
PubMed1986

[Echocardiographic diagnosis of infectious endocarditis on patent ductus arteriosus with involvement of the pulmonary artery and the pulmonary and aortic semilunar valves. Description of a case].

Infective endocarditis is one of the most rare complications of patent ductus arteriosus (PDA). Usually vegetations are localised at the level of the patent ductus and can involve the left branch and the trunk of the pulmonary artery. We report the case of a young woman with PDA, who was admitted to the hospital in severe congestive heart failure due to infective endocarditis. A 2D echocardiographic examination revealed vegetations into the ductus with extension to the pulmonary artery, pulmonary valve and aortic valve. The results of the echocardiographic study enabled us to evaluate the extension of the lesions, to avoid heart catheterization and to decide the most suitable surgical approach for repairing all the damage in one surgical operation.

Adult↗
PubMed1985

Mycotic tuberculous aneurysm of the descending thoracic aorta.

Tuberculous aneurysm of the aorta is a rare and dangerous condition. Despite modern diagnostic and surgical techniques, it remains a challenge to recognize and treat. A successful resection of a false aneurysm of the descending aorta that ruptured into the lung of a 55-year-old woman is reported. A history of the patient and microscopic examination of the specimen indicated a diagnosis of tuberculosis. Antituberculosis chemotherapy was immediately implemented. The patient appears to be in good condition 8 months after operation; however, she remains under treatment for tuberculosis.

Journal Article↗
PubMed1985

Chronic traumatic aneurysms of the descending thoracic aorta.

Between 1970 and December 1984, 28 patients with post-traumatic chronic aneurysm of the descending thoracic aorta were consecutively operated on in our Division of Cardiac Surgery. Ages ranged from 16 to 66 years (mean 38 years); 25 were male and three were female. In all cases, a history of a major deceleration injury was documented. The interval between trauma and operation ranged from 2 to 50 years (mean 11.4 +/- 7.8). Twenty-three (82.1%) were asymptomatic. Only one operation was performed on an urgent basis for recurrent episodes of hemoptysis. All patients underwent resection with prosthetic tubulargraft (25 cases) and patch-graft (3 cases) replacements. In all patients but one, left heart bypass was employed. No hospital deaths, late deaths, paraplegia or graft-related complications occurred. Considering the risk of late rupture and the young age of most of the patients, surgery in chronic post-traumatic aneurysms of the descending thoracic aorta is always indicated. We consider left heart bypass a safe technique in preventing renal and medullar ischemic injuries.

Journal Article↗
PubMed1985

[Reinterventions on cardiac valve prosthesis].

From January 1978 to December 1984, 214 patients underwent a total of 243 reoperations for repair or replacement of a prosthetic heart valve. On the basis of the number of valve reoperations in the same anatomic position within the heart, the patients were divided into three groups. Overall hospital mortality was 23.4% (CL 20.3-26.7) in Group I (214 patients), 48% (CL 36.1-60.1) in Group II (25 patients), 25% (CL 3.3-62.6) in Group III (4 patients). Hospital mortality appeared to be related to urgency of reoperation (p less than 0.001 in Group I; p = 0.037 in Group II), primary indication for reoperation (p = 0.034 in Group I; p = 0.022 in Group II), association with other cardiac surgical procedures (p = 0.00253 in Group I). Hospital mortality in Group I was significantly higher (p = 0.0056) when reoperation was performed within one year after valve replacement. No significant differences in urgency and emergency rate were noted between reoperations on mechanical heart valves and bioprostheses. No significant differences in bleeding complications were noted between reoperations and initial valve replacement. Mean follow-up is 37.4 +/- 21.8 months (range 2 to 85 months). Actuarial survival rate is 82.8 +/- 3.1% at 1 year, 78.7 +/- 3.5% at 2 years and 71.5 +/- 5.1% at 5 years; 90.9% (CL 87.4-93.6) of the followed patients are in I or II NYHA class. The results appear to suggest that when significant (on clinical or instrumental criteria) prosthetic disfunction is diagnosed, reoperation should be undertaken early to minimize operative risk. The Authors point out that surgery in such patients also ensures satisfying long-term results.

Follow-Up Studies↗