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Biomedical subjects

L Chiariello

Publications and source records attributed to L Chiariello.

At least 127 records · Page 7Linked to original sources
PubMed1977

[Replacement of cardiac valves with Björk-Shiley and Cooley-Cutter prostheses: a comparative study (author's transl)].

Björk-Shiley and Cooley-Cutter prostheses are the most satisfactory cardiac valves in our experience. They were compared in regard to incidence of emboli and mortality by long-term follow up. Among the 1904 patients who had received a Bjök-Shiley valve between 1969 and 1975 late follow-up could be obtained in 1565 patients. Among the 1329 patients with a Cooley-Cutter valve implanted between 1971 and 1975, late follow-up was obtained in 779. In the mitral valve replacement series, Cooley-Cutter / Björk-Shiley early mortality was 9.9/12.8 (%), late mortality 6.8/12.8 (%), early emboli 5.4/8.1 (%), late emboli 3.7/5.1 (%). In the aortic valve replacement series, Cooley-Cutter/Björk Shiley early mortality was 6.6/8.4 (%), late mortality 2.9/5.1 (%), early emboli 2.7/3.3 (%), late emboli 1.1/2.7 (%). Both early and late mortality and emboli were more favorable in the Cooley-Cutter sample as compared to the Björk-Shiley group. Therefore the Cooley-Cutter prostheses are preferred in both the aortic and mitral positions.

Aortic Valve↗
PubMed1976

[Aneurysm of pericardial right ventricular outflow tract patches (author's transl)].

Among 1022 patients who underwent total repair of tetralogy of Fallot, 252 patients received a pericardial patch of the right ventricular outflow tract (RVOT); and of these 10 subsequently developed an aneurysm of the RVOT. Cardiac catheterization and angiography revealed moderate pulmonary unsufficiency in all patients, a residual pressure gradient in the RVOT in seven and a residual ventricular septal defect in two patients. Surgery was indicated in eight patients because of progressive distension of the aneurysm. Reconstruction of the RVOT was accomplished by resection of the aneurysm and insertion of a woven Dacron patch in five patients, primary suture of the pulmonary artery in two and implantation of a woven Dacron conduit containing a Björk-Shiley valve in one patient. No early or late death occured. Although aneurysms of the RVOT with pericardial patches represent a rare complication after total correction of tetralogy of Fallot, we recommend primary reconstruction of the RVOT with a woven Dacron patch.

Child↗
PubMed1976

Surgical treatment of congenital valvular aortic stenosis.

Twenty-two patients with congenital valvular aortic stenosis were surgically treated between 1967 and July 1975. Five (23%) were under 1 year of age (group I) and 17 (77%) were between 2 and 24 years (group II). All infants exhibited severe congestive heart failure and electrocardiographi (ECG) evidence of left ventricular hypertrophy (LVH) with strain pattern. In group II, angina was present in three cases, syncope and fatigue in two; the ECG indicated LVH in 10 cases (59%) with strain pattern in five (29%). A bicuspid aortic valve was present in 77% (17/22) of the cases; 32% had other cardiac anomalies. Aortic valvotomy was performed on cardiopulmonary bypass in 20 cases, and with deep hypothermia and circulatory arrest in two. Three infants under 1 month of age with associated anomalies died (hospital mortality 14%). Intraoperative average peak left ventricular-aortic systolic pressure gradient decreased from 86 to 21 mmHg (P less than 0.001). Late clinical (in all cases) and haemodynamic (26%) follow-up showed severe restenosis in two patients of group II; one of them had a second operation, the other one died three and a half years postoperatively. Results assessed on the basis of symptoms, ECG changes, aortic valve function, and/or haemodynamic findings were fair in the two surviving infants. Results in group II were excellent in three, satisfactory in seven, fair in four, and poor in two cases. In infants, aortic valvotomy is a palliative procedure which carries a high risk. In the older age group, early and late results are more gratifying.

Adolescent↗
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

Aneurysm of the membranous ventricular septum. Surgical consideration and experience in 29 cases.

Twnety-nine cases of aneurysm of the membranous septum in association with various cardiac abnormalities are described. These aneurysms are more common than has been previously thought (10% of the total associated anomalies managed surgically). The patients' ages ranged from 3 months to 28 years. All of the 29 patients were divided into three groups. Group I consisted of 15 patients with ventricular septal defect (VSD), 5 of whom had associated artrial septal defect (ASD). Group II consisted of 5 patients with VSD and pulmonic obstruction, and Group III comprised 9 patients with transposition of the great arteries (TGA). Complete correction was performed in all the patients, and the aneurysm was imbricated in the suture line of the VSD in all cases but one. There was only one hospital death, the result of subpulmonic obstruction. This occurred in the first patient of this series, who had aneurysm of the membranous septum in TGA and VSD and in whom the aneurysm was not suspected preoperatively and was overlooked at surgery. There were no late deaths. In 5 patients a small residual VSD and in 3 patients a small recurrent aneurysm were found in a postoperative study. When these accompanying aneurysms are encountered during surgery or are previously diagnosed, resection or imbrication of the sac should be accomplished in order to prevent further enlargement or postoperative arrhythmias and, especially in TGA, to avoid fatal subpulmonic obstruction as occurred in our only death. According to the present data, in the presence of an aneurysm, even a small VSD should be closed by a patch and the aneurysm should perhaps be excised.

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

Conduit reconstruction of right ventricular outflow tract. Experience with 17 patients.

Evaluation was made of 17 patients who underwent conduit reconstruction of the right ventricular outflow tract (for anomalies other than truncus arteriosus) at the Texas Heart Institute between December, 1965, and June, 1974. Fifteen patients survived the operation and have shown substantial clinical improvement. Several different conduits were used, principally an allograft aorta with the aortic valve and mitral leaflet attached, a woven Dacron prosthesis containing a xenograft (porcine) valve, and a valveless Dacron tube graft. Allograft conduits are sometimes difficult to procure and keep and tend to calcify with passage of time. Woven Dacron prostheses are favored because they are readily available in a wide range of sizes. We believe it is not necessary for the conduit to contain a valve unless the patient has pulmonary hypertension, in which case we use a xenograft (porcine) valve because this valve does not require the long-term use of anticoagulants, a difficult regimen to manage in children. The largest possible prosthesis must be used; otherwise right ventricular hypertension will persist. Indications for conduit reconstruction include anomalous coronary arteries crossing the right ventricular outflow tract, discontinuity of the pulmonary arteries, and pulmonary atresia with a ventricular septal defect. Our current method of managing pulmonary atresia with ventricular septal defect (pseudotruncus arteriosus) includes palliative shunting to relieve hypoxemia during infancy and to permit full development of the pulmonary arteries for eventual total correction at a more optimal age when a larger conduit may be used.

Adolescent↗
PubMed1975

Surgical treatment for anomalous origin of left coronary artery from pulmonary artery.

Anomalous origin of the left coronary artery from the pulmonary artery carries a poor prognosis; most patients die early in life from myocardial infarction and congestive heart failure. During a 12-year period at the Texas Heart Institute, 13 patients with this congenital malformation ranging in age from 1 to 24 years underwent operation. The anomalous coronary artery was sutured or ligated, or both, close to the pulmonary artery in 3 patients, 2 before 1965. Aortocoronary bypass was performed in the remaining 10 patients, using an autogenous saphenous vein graft in 9 and a Dacron tube in 1. More recently a distal end-to-side anastomosis has been employed and is not the preferred method. If necessary, a pump oxygenator may be used to complete the procedure. The only death was that of the first patient in the series who underwent ligation of the left coronary artery and mitral annuloplasty for severe mitral insufficiency; Of the 12 patients available for long-term follow-up study, all but 1 were asymptomatic. Follow-up angiographic studies showed the graft to be patent in 7 patients; the longest period of graft patency was 8 years. Definitive operative therapy is preferable to simple ligation because it eliminates the left-to-right shunt from the right coronary artery to the pulmonary artery and establishes a double coronary artery system.

Adolescent↗
PubMed1975

Coronary artery anomalies in patients with tetralogy of Fallot.

A left anterior descending coronary artery arising from the right coronary artery can be easily injured during performance of a right ventriculotomy for correction of tetralogy of Fallot. This occurred in 2 of the 23 patients in this series, and both patients died from myocardial failure in the early period after operation. Of 19 patients who presented a combination of tetralogy of Fallot and unusual coronary artery distribution, injury to the abnormal coronary artery was avoided by a transverse right ventriculotomy either alone or combined with an upper vertical incision in 17 patients. In 2 patients a Dacron tube graft was inserted between the right ventricular outflow tract and the pulmonary artery. In 2 patients a right ventriculotomy was avoided by closing the ventricular septal defect through a transaortic approach. All 21 patients survived. Before a vertical or longitudinal incision in the right ventricular outflow tract is performed, the coronary artery distribution should always be checked and confirmation made of the normal origin of the left anterior descending branch from the left coronary artery to the left of the pulmonary artery.

Adolescent↗
PubMed1975

Intracardiac repair of tetralogy of Fallot. Five-year review of 403 patients.

During the 5 year period 1969 to 1973, 403 patients underwent intracardiac repair of tetralogy of Fallot. The patients ranged in age from 3 months to 41 years. Before operation, 86 per cent were cyanotic and 14 per cent were acyanotic. Forty-nine per cent had had at least one palliative procedure before total correction. Mahor associated anomalies included atrial septal defect in 24 per cent, patent ductus arteriosus in 2.5 per cent, coronary anomalies in 4 per cent, and left superior vena cava in 4.5 per cent. Seven per cent of the patients had pulmonary atresia. Pulmonary valvotomy was performed in 111 patients and complete excision of the pulmonary valve in 151. Patch graft reconstruction of the right ventricular outflow tract was performed in 57 per cent of the patients. In 11 patients a conduit was used to connect the right ventricle to the pulmonary artery. The over-all hospital mortality rate was 9.5 per cent, with the lowest rate (3.5 per cent) in the age group 6 to 10 years and the highest in the infant and adult groups (16.5 and 14.5 per cent, respectively). Three known late deaths occurred. A residual ventricular septal defect (VSD) was found in 3 per cent of the patients and an aneurysm of the pericardial patch in the right ventricular outflow tract developed in 7 patients. Intracardiac repair of the tetralogy of Fallot can be performed with reasonable risk and low morbidity. In our experience the optimal age for elective surgery is between 6 and 10 years.

Adolescent↗
PubMed1975

[Clinical experinece using tubular grafts in the reconstruction of the right ventricular outflow tract (author's transl)].

Conduit reconstruction of the right ventricular outflow tract is useful in treatment of a variety of congenital cardiac malformations. Seventeen patients underwent conduit reconstruction at the Texas Heart Institute between December 1965 and June 1974. Fifteen patients survived the operation and have significantly improved. Several different conduits were used: allograft aorta with the aortic valve and mitral leaflet attached, a woven Dacron prosthesis containing a prosthetic valve, a prosthesis containing a xenograft (porcine) valve and a valveless Dacron tube graft. Allograft conduits present difficulties with procurement and inventory and tend to calcify with time. Woven Dacron prostheses are favored because of ready availability in a wide range of sizes. In the case of pulmonary hypertension, we use a conduit containing a xenograft (porcine) value. The largest conduit possible must be used. Indications for conduit reconstruction include anomalous coronary arteries, discontinuity between the pulmonary arteries and pulmonary atresia with a VSD. Our current method of management of pulmonary atresia with VSD includes palliative shunt during infancy to permit full development of the pulmonary arteries for total correction at a more optimal age when a larger conduit may be used.

Adolescent↗
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 pulmonary mock circulation model for a better understanding of protamine reversal of heparin.

Neutralization of heparin by protamine is a common procedure following extracorporeal circulation (cardiopulmonary bypass) of blood. Protamine administration has been shown to cause serious hemodynamic derangement in some patients. Obstruction of the pulmonary vascular bed following protamine administration has been suggested to be the primary cause of hemodynamic changes. The present study was undertaken to test the hypothesis that macromolecular complexes formed between cationic protamine with anionic heparin or other plasma components cause the obstruction of the vascular bed. An in vitro mock circulation model was designed to examine the formation of such complexes. In this model, blood or plasma was passed through a glass bead column at a constant flow rate while the pressure between the syringe pump and the column was closely monitored. No increase in pressure was noted when blood, plasma or saline alone or with added heparin were passed through the column. Addition of protamine to either blood or plasma resulted in a significant increase in the pressure; this increase was even greater when heparin was also present in the test medium. That the increase in pressure was due to the obstruction of the column was confirmed by using 1251-protamine and documenting that complexes formed between protamine and plasma proteins/heparin were retained in the column. These observations suggested that protamine formed large insoluble complexes with plasma proteins. Heparin appeared to help consolidate these complexes thus causing a rapid increase in the pressure. This may explain why the hemodynamic changes following protamine administration are more pronounced in patients with circulating heparin.

Blood↗