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Biomedical subjects

Francesco Donatelli

Publications and source records attributed to Francesco Donatelli.

32 records · Page 2Linked to original sources
PubMed2004

Posterior mitral valve restoration for ischemic regurgitation.

Chronic ischemic mitral regurgitation is traditionally a complex lesion to repair. Only restrictive annuloplasty has become an accepted strategy to avoid valve replacement, but results are unsatisfactory in some subgroups of patients. We describe an original technique that addresses the pathophysiologic mechanisms responsible for one of the most common subtypes of ischemic mitral regurgitation, ie, asymmetric tethering of the mitral leaflets after inferior myocardial infarction. The technique includes partial detachment of the posterior leaflet from the mitral annulus, annular plication, and posterior cusp plasty.

Chordae Tendineae↗
PubMed2004

Simplified thoracic aortic aneurysm repair.

Descending thoracic and thoracoabdominal aortic operations still represent a challenge for the cardiovascular surgeon. In recent years, endovascular stent grafting has become a popular alternative to a conventional operation in selected patients, but is not always readily available or is technically contraindicated; also, long-term results are unknown. We describe a simplified surgical technique to secure a standard vascular prosthesis by performing a modified "elephant trunk" operation and discuss potential indications for its application.

Aged↗
PubMed2003

An alternative technique for non-infective paraprosthetic leakage repair.

Severe paravalvular leak is generally a reason for the repetition of valve replacement surgery. On the contrary management of patients with mild and moderate defects is controversial. Long-term prognosis may be negatively affected if non-surgical strategy is adopted also in less symptomatic patients. The proposed technique of leak closure preserves the implanted prosthesis and may be useful in non-infective mild and moderate detachments. It may safely extend surgical treatment to less symptomatic patients suffering from this surgical complication.

Heart Valve Prosthesis↗
PubMed2003

Early surgical anteroseptal ventricular endocardial restoration after acute myocardial infarction. Pathophysiology and surgical considerations.

BACKGROUND: The efficacy and safety of surgical anteroseptal ventricular endocardial restoration (a procedure that excludes non-contracting scarred segments) in the left ventricle with chronic dilation and remodeling secondary to an anterior myocardial infarction are well established. We present a small series and discuss the indication for early left ventricular restoration in the setting of complicated acute myocardial infarction. METHODS: Early ventricular restoration was performed in 8 patients (4 males, 4 females, mean age 70 +/- 8 years). A postinfarction ventricular septal defect was diagnosed in 3 cases. All patients were operated, on an urgent or emergent basis, between 1 and 16 days following the onset of infarction. Surgical coronary revascularization was associated in 7 patients. RESULTS: There was one operative death. At discharge, echocardiographic morphofunctional assessment revealed: a reduction of the left ventricular end-diastolic and end-systolic volume indexes, an increase of the ejection fraction, and, most importantly, an improvement of remote myocardial shortening fraction. At a mean follow-up of 15.6 months (range 2-21 months), there were no late deaths and all survivors are in NYHA functional class I or II. CONCLUSIONS: Left ventricular restoration may represent an effective adjunct to the surgical management of patients with an acute extensive anterior myocardial infarction complicated by severe heart failure, with or without septal rupture.

Aged↗
PubMed2003

[Resection of unusual atrial mass complicated with fungal endocarditis in a patient undergoing immunosuppressive treatment].

Nodules of mesothelial and monocytic cells (Mesothelial/Monocytic Incidental Cardiac Excresences; MICE) are rare cardiac lesions, non neoplastic, possibly reactive and in part derived from mesothelium. A 76 years old woman, treated with low dose of steroid and methotrexate for rheumatoid arthritis, underwent surgical excision of cardiac "MICE". Postoperative period was complicated with early and severe fungal endocarditis requiring reintervention. Two aspects are of interest: rarity of both cardiac pathologies and the possible relation to immunosuppressive therapy. Treatment of fungal endocarditis should be aggressive, overall survival is rather poor. Possibility to discontinue immunosuppressive treatment should be considered before cardiac surgery.

Aged↗
PubMed2002

Clonidine for treatment of postoperative pain: a dose-finding study.

The aim of this double-blind randomized study was to evaluate the optimal intravenous dose of clonidine administrated during the peri-operative period, after lumbar hemilaminectomy for herniated disk repair. The "optimal intravenous dose" was defined as that providing minimal analgesic request, stable haemodynamic profile and a minimal sedation score during 12h after extubation. Eighty adult patients, ASA physical status I-II, undergoing lumbar hemilaminectomy for herniated disk (L(4)-L(5), L(5)-S(1)) were included in the study. All the patients were randomly assigned to one of four study groups (A, B, C, D), 20 patients each. The same standardized general anaesthesia was performed for each group. Thirty minutes before the end of surgery, group A, B and C patients received three different loading doses of intravenous clonidine (5 microg/kg, 3 microg/kg, 2 microg/kg respectively), followed by the same infusion of intravenous clonidine (0.3 microg/kg per hour). Group D patients received a bolus dose and a continuous infusion of NaCl 0.9%. In the recovery unit, postoperative pain was treated by a patient-controlled analgesia device, containing morphine. Pain relief was evaluated by the total morphine requirement during the postoperative period. Systolic blood pressure (SBP), heart rate and sedation were also noted during the first 12h postoperatively. Intravenous clonidine decreased morphine requirements in a dose-dependent manner. Group A, B, C and D patients requested 5 +/- 2, 11 +/- 3, 19 +/- 4 and 29 +/- 8 doses of morphine respectively. Clonidine also affected SBP in a dose-related manner. Group A, B and C patients had an SBP decrease respectively of 26 +/- 3%, 7 +/- 4% and 2 +/- 2% compared with basic values while, at the same time, in group D patients no SBP variation was registered. In conclusion, this study demonstrates that, when sedation and analgesic effect of clonidine is required, 3 microg/kg bolus dose followed by a continuous infusion of 0.3 microg/kg per hour has to be considered the optimal intravenous dose. The higher dose of intravenous clonidine (5 microg/kg) produced better analgesia but the degree of hypotension and sedation was more severe and longer lasting; it required ephedrine administration and careful monitoring of the patient. On the other hand, the bolus of intravenous clonidine 2 microg/kg (group C) was less effective in terms of pain relief but with similar side-effects to the 3 microg/kg dosage (group B).

Adult↗
PubMedDate not supplied

Comparison of analgesic methods for total knee arthroplasty: metabolic effect of exogenous glucose.

BACKGROUND AND OBJECTIVES: This study was set up to assess whether postoperative suppression of gluconeogenesis by dextrose infusion would be influenced by continuous peripheral nerve block (CPNB) with local anesthetics, in comparison with epidural and with intravenous analgesia. METHODS: Twenty-seven patients, undergoing elective primary total knee arthroplasty for osteoarthritis, were randomly allocated to one of the three groups of 9 patients each: patient controlled analgesia (PCA) with i.v. morphine, epidural with bupivacaine 0.1% and fentanyl 3mug/ml, or continuous femoral and sciatic blocks with ropivacaine 0.2%. Endogenous glucose production, an index of gluconeogenesis, and glucose clearance, an index of whole body glucose uptake, were assessed on the second postoperative day by measuring [6,6-(2)H(2)]glucose kinetics after an overnight fast (fasted state), and during a 3-h period infusion of dextrose at 4 mg/kg/min (fed state). Visual analog scale (VAS) at rest and at knee flexion, use of morphine, mobilization, nutritional intake, and bowel function were also collected. RESULTS: Endogenous glucose production was totally suppressed by 3 h of dextrose infusion in all 3 groups (P < .001) while glucose clearance was unchanged. Blood glucose and insulin increased (P < .001), while glucagon decreased, with the greatest change in the epidural group (P < .05). VAS at rest and at knee flexion was significantly lower in patients receiving epidural and CPNB compared to i.v. morphine (P < .05). Restoration of bowel function, assessed as return of bowel movements, was faster in the CPNB group (P < .05). CONCLUSION: Excellent analgesia was achieved in the epidural and continuous nerve block groups. Postoperative gluconeogenesis was totally suppressed by dextrose infusion independent of the analgesia technique with no change in glucose utilization.

Aged↗