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Biomedical subjects

G D Angelini

Publications and source records attributed to G D Angelini.

At least 217 records · Page 12Linked to original sources
PubMed1989

The future of saphenous vein as a coronary artery bypass conduit.

Continuing widespread use of autologous saphenous vein for coronary artery bypass grafting seems unavoidable despite its poor-term patency. We review here the evidence that platelet activation is responsible for early and late vein graft occlusion and conclude that other mechanisms probably contribute to late occlusions. We suggest that a rational strategy to improve vein graft patency should include: improved endothelial preservation during surgical implantation; use of better antiplatelet agents, in particular those which prevent platelet adhesion as well as aggregation; reduction of risk factors including serum cholesterol; and application of agents (e.g. heparin) which inhibit smooth muscle cell proliferation directly. We draw parallels between the pathogenesis of vein graft occlusion and coronary atherosclerosis and suggest that testing strategies for improving vein graft patency may also shed light on atherogenesis.

Coronary Artery Bypass↗
PubMed1989

Coronary artery bypass surgery: current practice in the United Kingdom.

A survey of current clinical practice was carried out among the 84 consultant cardiac surgeons currently performing coronary artery bypass surgery in the United Kingdom. The 80 surgeons who returned the questionnaire performed an estimated total of 17,100 coronary artery bypass graft operations in 1987, a mean case load of 214 operations each. Sixty two of the 80 surgeons regarded the internal mammary artery as the graft conduit of choice, and seven preferred the saphenous vein. The internal mammary artery was used in 73% of bypass grafts to the left anterior descending coronary artery but in only 4% of grafts to the circumflex and right coronary systems. Contraindications to the use of the internal mammary artery included advanced age of the patient (51 surgeons), insufficient flow through the internal mammary artery (49), and endarterectomy (35). Seventy four of the 80 surgeons considered intraoperative damage to the saphenous vein to be a possible cause of vein graft failure, but there was no agreement about how it should be reduced. All surgeons advocated pharmacological measures to enhance graft patency. Dipyridamole and aspirin constituted the most popular regimen (58 surgeons), though only 28 started dipyridamole preoperatively. Warfarin was prescribed postoperatively on occasion by 22 surgeons, but 14 of these used it only after endarterectomy.

Aged↗
PubMed1989

Traumatic rupture of the thoracic aorta.

Traumatic rupture of the thoracic aorta is a lethal injury associated with high speed accidents. In multiply injured patients a high index of suspicion is required to allow prompt diagnosis of this condition. Urgent surgery is life saving in the majority of patients.

Adult↗
PubMed1988

Endothelial function can be preserved during cryo-storage of human saphenous vein.

Endothelial functional integrity was quantified in human saphenous vein by measurement of stimulated (vortex-mixing) rates of prostacyclin production. Prostacyclin production was not inhibited by dimethylsulphoxide (DMSO), glycerol or sucrose at concentrations normally used for cryopreservation. Rapid freezing followed by storage for 3-4 weeks and thawing of veins pretreated with 15% (v/v) dimethylsulphoxide significantly impaired prostacyclin production. In contrast, slow freezing and thawing in the presence, but not the absence, of DMSO led to complete retention of prostacyclin production. We conclude that endothelial function can be preserved during cryostorage.

Cryopreservation↗
PubMed1988

Left atrial ball thrombus: echocardiographic features and clinical implications.

The echocardiographic features of left atrial ball thrombus associated with mitral stenosis are reviewed, and some previously unpublished cross-sectional echocardiographic findings presented. In one patient who had a large free-floating ball thrombus there was variation in its echocardiographic appearance; the thrombus was removed uneventfully at surgery. In another patient who had a pedunculated but immobile ball thrombus, a stalk was identified which attached it to the inter-atrial septum; this patient died suddenly before surgery could be performed, due to detachment of the thrombus and obstruction of the mitral valve orifice. Cross-sectional echocardiography is clearly superior to M-mode imaging in the detection of atrial thrombi, and variable appearances may help differentiation of thrombus from myxoma. Whether or not a ball thrombus appears mobile, emergency thrombectomy and mitral valve replacement is indicated, because of the risk of obstruction of the mitral valve.

Echocardiography↗
PubMed1987

Poststernotomy pseudo-arthrosis due to foreign body reaction to bone wax.

A case of repeated pseudo-arthrosis of the sternum following two median sternotomies for coronary artery bypass surgery is reported. This was due to a chronic foreign body reaction to the bees' wax used during the first operation to reduce bleeding from the sternal edges.

Coronary Artery Bypass↗
PubMed1987

The incidence and significance of early pericardial effusion after open heart surgery.

The presence and severity of postoperative pericardial effusions were studied echocardiographically in 114 consecutive patients (70 males, 44 females; mean age 56 +/- 10 years). An effusion was present in 35 patients at 3-5 days. An effusion was less common when a drainage tube was inserted for 24-36 h in the posterior as well as the anterior mediastinum than when only an anterior drain was used. Patients with effusions differed from those without in having more supraventricular arrhythmias, more wound infections, smaller total blood drainage and longer postoperative hospital stay. Three patients with posterior pericardial effusions developed cardiac tamponade 5-18 days postoperatively. The data show that pericardial effusions are associated with postoperative complications and suggest that effusion formation can be reduced by using posterior as well as anterior chest drains.

Cardiac Surgical Procedures↗
PubMed1987

Preparation of human saphenous vein for coronary artery bypass grafting impairs its capacity to produce prostacyclin.

Prostacyclin production was measured from freshly isolated human saphenous vein and from vein subjected to routine surgical preparation for coronary bypass grafting. Surgical preparation had no effect on spontaneous prostacyclin production but significantly reduced stimulated rates from 16.9(1.1) to 7.1(0.5) pg.min-1 per mg wet weight (n = 27). Stimulated prostacyclin production was not reduced by storage of vein for 2 h at 23 degrees C in blood or saline nor by distension, but it was reduced to 5.0(0.6) pg.min-1 per mg (n = 10) by de-endothelialisation. Reduced prostacyclin production, which might in itself contribute to vein graft occlusion, provides a quantitative biochemical estimate of endothelial integrity.

Aged↗
PubMed1987

Nature and pressure dependence of damage induced by distension of human saphenous vein coronary artery bypass grafts.

Surgical preparation of human saphenous vein for coronary artery bypass grafting involving distension and storage in iso-osmotic sodium chloride solution reduced tissue adenosine triphosphate (ATP) (mean(SEM] concentration from 280(20) nmol.g-1 wet wt (n = 25) to 140(30) nmol.g-1 wet wt (n = 12) and the adenosine triphosphate to adenosine diphosphate (ATP:ADP) concentration ratio from 2.4(0.1) to 1.2(0.2). Since removal of endothelium from freshly isolated vein did not affect ATP concentration or ATP:ADP ratio, these changes quantified medial damage. Distension of the vein at a pressure of 150 mmHg caused no change in ATP concentration or ATP:ADP ratio, but these values were reduced progressively by distension at 300 mmHg and 600 mmHg. Damage was not reversed but was exacerbated by subsequent incubation of the distended vein in blood. Distension of the vein at 600 mmHg caused release of tissue lactate dehydrogenase. The data show that acute medial damage can result from distension of the vein but that this does not occur at pressure equivalent to normal arterial pressure. Distension induced medial damage is unlikely to be rapidly reversible.

Adenosine Triphosphate↗
PubMed1987

A surgical preparative technique for coronary bypass grafts of human saphenous vein which preserves medial and endothelial functional integrity.

Measurements of adenosine triphosphate concentration and adenosine triphosphate/diphosphate ratio provided quantitative markers for medial integrity and stimulated (vortex-mixing) prostacyclin production for endothelial function. Freshly isolated vein had an adenosine triphosphate concentration of 470 +/- 60 nmol X gm-1 wet weight and an adenosine triphosphate/diphosphate ratio of 2.50 +/- 0.13; it produced prostacyclin at a rate of 9.3 +/- 1.0 pg X min-1 X mg-1 wet weight. Vein subjected to dissection, proximal anastomosis, and distention with the patient's own arterial pressure had an adenosine triphosphate concentration of 490 +/- 70 nmol X gm-1 wet weight and an adenosine triphosphate/diphosphate ratio of 2.29 +/- 0.13; it produced prostacyclin at a rate of 10.4 +/- 2.2 pg X min-1 X mg-1 wet weight. All values were indistinguishable from those in freshly isolated vein. In vein subjected to dissection, distention at less than 300 mm Hg with patient's heparinized blood, and distal anastomosis, adenosine triphosphate concentration, adenosine triphosphate/diphosphate ratio, and prostacyclin production (5.5 +/- 0.6 pg X min-1 X mg-1 wet weight) were all significantly (p less than 0.001) reduced. These results demonstrated that surgical preparation by first proximal anastomosis preserved both medial and endothelial function.

Adenosine Diphosphate↗
PubMed1987

[Echocardiographic diagnosis of left ventricular myxoma. Description of a case and review of the literature. Myxomas of the left ventricle].

A case of left ventricular myxoma diagnosed by echocardiography and successfully removed by left ventriculotomy is reported. This is a 21 year old male, with the few symptoms which simulating an hypertrophic cardiomyopathy in contrast to the large size of the tumour. It is possible that myxomas are responsible for sudden death. Therefore, in presence of new cardiac signs kind and relevance, the possibility of a myxoma should be considered. The diagnosis can be easily ruled out (or confirmed) by echocardiography, which represents a valuable tool in the diagnosis of myxomas.

Adult↗
PubMed1986

Malfunction of a Lillehei-Kaster aortic valve presenting as loss of the normal valve click.

We report a patient with a malfunctioning Lillehei-Kaster aortic valve which presented only as loss of the normal valve click, 7 months after temporary interruption of anticoagulation at the time of abdominal surgery. Loss of a normal prosthetic valve click may be the only sign of prosthetic valve malfunction, and it is a surgical emergency. Patients with prosthetic heart valves, who undergo non-cardiac surgery, should not receive vitamin K1, and anticoagulation should be restarted promptly after surgery with intravenous heparin as well as warfarin.

Aortic Valve↗
PubMed1986

Myxoma of the left ventricle.

We report a case of left ventricular myxoma in a 19-year-old man which presented as intermittent aortic valve obstruction. Echocardiography provided a comprehensive diagnosis, and excision through a left ventriculotomy was safely accomplished.

Adult↗