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Biomedical subjects

J Agosti

Publications and source records attributed to J Agosti.

At least 55 records · Page 3Linked to original sources
PubMed1976

Coarctation of the aorta in children and adolescents. Surgical treatment and review of 120 patients.

Between September 1967 and April 1975, a total of 120 patients between one day and 20 years of age underwent surgery for coarctation of the thoracic aorta. Thirty-two patients were below two years of age (group 1) and 88 were above two years (group 3). All patients in group 1 initially had congestive heart failure. Twenty-eight had associated cardiac defects, and 18 had signficant pulmonary arterial hypertension (greater than 50 mm Hg). Operative deaths occurred only in group 1, all in infants below five months of age. Common features in the 13 deaths were congestive heart failure, pulmonary hypertension, patent ductus arteriosus, large ventricular septal defect, concomitant pulmonary arterial bandling or open-heart procedures. The only recurrence occurred in an infant first operated at 14 days of age. Resection of aortic coarctation can be safely performed as an elective procedure; however, it still presents a high surgical risk in infants with associated intracardiac defects. Late follow-up shows the salutary effects of repair of the coarctation on hypertension.

Adolescent↗
PubMed1976

Combined mitral and aortic valve replacement with the Börk-Shiley prosthesis.

Combined mitral and aortic valve replacement with the BJORK-Shiley tilting-disc valve prosthesis was performed in 42 patients. Hospital and late mortality rates were both at the 9.5% level. No correlation was seen between mortality and combination of concomitant valve lesions. Morbidity was elevated. No episodes of embolism were observed after surgery, although one patient died of severe haemorrhage. Only one patient showed valvular dysfunction (grade 2/4 leakage), but did not require reoperation. Postoperatively, 75.7% of the patients were asymptomatic for a mean follow-up period of 21.1 months. The Björk-Shiley prosthesis offers a small gradient associated with a low profile, which constitute important advantages in multiple valve replacement.

Adolescent↗
PubMed1976

Congenital aortic stenosis. Experience with 43 patients.

Between September, 1967, and January, 1975, 43 patients underwent intracardiac repair for congenital aortic stenosis at the Buffalo Children's Hospital. The patients ranged in age from 2 days to 24 years, 6 of them being below one year of age. Valvular aortic stenosis was found in 21 cases (4 infants [Group I-A] and 17 older patients [Group I-B]), discrete subaortic membranous diaphragm in 11 (Group II); diffuse subvalvular muscular obstruction in 3 (Group III), supravalvular stenosis in 4 (Group IV), and multiple-level obstruction in 4 (2 infants [Group V-A] and 2 older patients [Group V-B]). Preoperatively, 58 per cent of the patients were symptomatic and 67 per cent had abnormal electrocardiograms. Associated congenital cardiac defects were found in 28 per cent of the cases. The over-all hospital mortality rate was 9 per cent (3 patients in Group I-A and one in Group V-A), with no deaths occurring in patients older than 3 months of age at the time of operation. Two late deaths occurred (Groups I-B and V-B). A complete heart block developed in one patient (Group III). The average intraoperative peak systolic left ventricular-aortic gradient decreased in all groups after repair but progressively increased in the late hemodynamic studies obtained in symptomatic patients. Six patients were reoperated upon for recurrent obstruction. Late results were evaluated on the basis of symptoms, electrocardiographic findings, valve function, and hemodynamic data. They showed excellent or satisfactory results in 59 per cent of the patients in Group I-B, in 45 per cent in Group II, in 66 per cent in Group III, and in 25 per cent in Group I-V. Results were fair or poor in Groups, I-A, V-A, and V-B. In children and adolescents, effective relief of the obstruction and of the symptoms can be obtained with minimal operative risk and minimal morbidity. In symptomatic infants, despite the high operative mortality rate, surgical intervention is indicated because of the poor prognosis.

Adolescent↗
PubMed1975

Thermodilution cardiac output measurement in infants and small children following intracardiac surgery.

A modified catheter has been used in conjunction with a thermodilution cardiac output computer for postoperative assessment of cardiac function in infants and children. Because of the small amount of fluid required for each determination and the simplicity of the technique, serial measurements can be done safely. Its use has contributed to the early detection of low output states. It has also proven to be a useful tool for estimating the optimal heart rate in each patient and for assessing the effectiveness of therapeutic measures.

Cardiac Catheterization↗
PubMed1975

Corrective treatment of isolated ventricular septal defect in infancy.

Intracardiac correction of VSD in infants should be indicated if the mortality and morbidity of the operation at this age group is lower than cumulative mortality of pulmonary artery banding plus second-staged procedure mortality. Experience with closure of VSD in 23 patients under 1 yr of age with 4% mortality and low morbidity is presented. Indications for operation are: (1) intractable heart failure; (2) persistence or progression of pulmonary hypertension; and (3) failure of banding procedure. Deep hypothermia and circulatory arrest facilitated the intracardiac repair in all patients. Mortality and morbidity related to the banding procedure are emphasized, and it is suggested that banding be restricted only to patients with associated coarctation of the aorta or to patients with multiple muscular ventricular septal defects in whom left ventriculotomy can be safely performed at an older age.

Heart Failure↗
PubMed1975

The surgical treatment of coarctation of the aorta.

Patients with coarctation of the aorta have a significantly decreased life expectancy. Surgical correction is curative and involves a low mortality rate which increases with coexisting cardiovascular abnormalities. In our series, there were no operative deaths in patients with pure coarctation of the aorta. Age is an important factor and postoperative complications were more frequent in older patients. Re section of the narrowed area with end-to-end anastomosis is the technique of choice. If theis is not possible, a Dacron tube is a good alternative. Early diagnosis and early intervention are of utmost importance, even in asymptomatic patients.

Adolescent↗
PubMedDate not supplied

Pulmonary arteriovenous fistula. A review.

A successfully treated case of an arteriovenous fistula of the lung is reported. An exhaustive review is made of the pertinent literature and the pathophysiology, embryology, clinical aspects, diagnosis and treatment are discussed.

Arteriovenous Fistula↗
PubMedDate not supplied

[Open mitral commissurotomy. Indications and results].

We have reviewed the clinical history of 106 patients that were done an open mitral commissurotomy from june 1971 to march 1974. Hospital mortality was less than 1% and morbility was low. The patients average age was 40 years. Fifteen patients had suffered a previous closed mitral commissurotomy, and systemic embolism occurred in 62.2% of them. Ninety eight of the surviving patients have been followed; 80.6% of them had improved by at least one degree of the N.Y.H.A. functional scale. According to these results we have widened the indications for open mitral commissurotomy. However, we still use the closed technique in young patients without previous mitrol commissurotomy or past history of system embolism, which no fluoroscopic evidence of mitral valve calcifications and without associated valvular lesions.

Adult↗
PubMedDate not supplied

Intracardiac repair of isolated ventricular septal defects below two years of age.

Experience with closure of ventricular septal defect in 32 patients under two years is presented. Indications for correction were: (a) intractable heart failure; (b) persistence of progression of pulmonary artery hypertension; (c) failure of pulmonary artery banding; (d) elective closure after banding. In all but one case, the correction was done under the surface induced deep hypothermia with limited cardiopulmonary bypass and total circulatory arrest. Mortality and morbidity of the pulmonary artery banding procedure and of early closure discussed. For the corrective procedure the mortality was 3%. It is emphasized that whenever clinical or hemodynamic data support persistence or progression of pulmonary artery hypertension, corrective repair should be performed without delay. It is further suggested that pulmonary artery banding should be restricted to patients with ventricular septal defect and associated coarctation of the aorta and to patients with multiple muscular ventricular septal defects.

Child, Preschool↗
PubMedDate not supplied

A comparative study of the St. Jude Medical and Björk-Shiley convexo-concave prostheses in isolated valve replacement.

This is a study of 199 consecutive patients who survived isolated mitral or aortic valve replacement with a Björk-Shiley (B-S) or St. Jude Medical (SJM) prostheses. Mean follow-up was 36 months. Preoperative status was similar for both groups (B-S or SMJ). Five year survival rates for mitral valve replacement (MVR) were 91% for B-S and SJM, and for aortic valve replacement (AVR) 96% vs 91% for SJM (p less than 0.06). Linearized incidence of thromboembolism in MVR was 5.62% patient year for BS and 5.23% patient year for SJM (p = NS). Classical risk factors for thromboembolism were evaluated on a univariate analysis: no single risk factor was identified. Only the association of two or more was possibly significant. The presence of inadequate anticoagulation (prothrombin index greater than 50%) was the main risk factor for thromboembolism, as the incidence rate was 19% per patient year when poorly anticoagulated versus 4.6% per patient year incidence in the whole series (p less than 0.01).

Actuarial Analysis↗
PubMedDate not supplied

[Patch angioplasty in isolated left main coronary artery stenosis].

A 50 year old male with isolated left main coronary artery disease was surgically treated with saphenous vein patch angioplasty. Surgery results are reviewed by coronariography 2 months later and we comment its use as alternative technique in selected cases.

Blood Vessel Prosthesis↗
PubMedDate not supplied

Anomalous origin of the left coronary artery from the pulmonary artery. Surgical alternatives depending of the age of the patient.

Four cases of anomalous origin of the left coronary artery from the pulmonary artery, three of which were operated upon in our Centre, are presented. An aortocoronary bypass with reversed autologous saphenous vein was carried out in both of the children; and in the adult, the anomalous ostium was closed from the interior of the pulmonary artery. After 84, 72, and 4 months of evolution, respectively, they were found to be asymptomatic, the mitral insufficiency had disappeared and the venous graft remained patent. In this paper, the clinical form of presentation, diagnostic possibilities and surgical treatment are analysed.

Child, Preschool↗