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Biomedical subjects

L Daliento

Publications and source records attributed to L Daliento.

At least 91 records · Page 5Linked to original sources
PubMed1984

Operative risk of correction of atrioventricular septal defects.

Between 1 January 1975 and 31 December 1982, 111 patients with atrioventricular septal defect underwent surgical repair. Of these, 43 had the complete, 11 the intermediate, and 57 the partial form. The postoperative mortality rate was 37%, 9%, and 6% respectively. To determine which factors were independently responsible for the operative risk multivariate analysis of the surgical mortality was applied simultaneously to all three forms of the malformation. The form of defect, although strongly influencing the natural history and clinical presentation, was not by itself an operative risk factor. The risk was related primarily to failure to obtain a well functioning atrioventricular valve, to the presence of left ventricular dominance, to the degree of pulmonary vascular resistance, and, finally, to the technique of reconstructing a two leaflet left atrioventricular valve. The small size of the patient was also a significant incremental risk factor, but if the other factors were not unfavorable good results could be achieved in small infants with mortality rates less than 10%. Multivariate analysis showed that severe postoperative left atrioventricular valve malfunction was related to the technique used to reconstruct a "normal" two leaflet left atrioventricular valve. These findings support the policy of reconstructing the left atrioventricular valve as a three leaflet valve. Nevertheless, the implicit beneficial effect of this technique has not as yet proved to be statistically significant.

Abnormalities, Multiple↗
PubMed1984

The surgical anatomy of hearts with no direct communication between the right atrium and the ventricular mass--so-called tricuspid atresia.

Seventy-six hearts were studied having no direct communication between the right atrium and the ventricular mass. The different cardiac chamber combinations producing so-called "tricuspid atresia" were considered. The nature of the atrioventricular valve atresia, the morphology of the ventricular mass, the size and position of the interventricular communication, the ventriculoarterial connection, and the presence of subarterial outflow tract obstruction were all analyzed. The majority of cases were of the "classical" type, i.e., absent right atrioventricular connection with the left atrium connected to the left ventricle. In another group there was absence of the right atrioventricular connection but the left atrium drained into the morphologically right ventricle, which was left-sided. In a third group both atrial chambers connected with the ventricular mass but some structure, an imperforate valve or muscular partition, completely blocked the flow pathway through the right side of the heart. All the hearts described are candidates for the Fontan procedure with either an atrioventricular or an atriopulmonary conduit. The surgical options would not be affected by the observed variability at the atrioventricular junction but would be dictated by the feasibility of incorporating the subpulmonary ventricle within the pulmonary circulation.

Heart Atria↗
PubMed1983

M-mode contrast echocardiography in patients with univentricular heart.

M-mode echocardiographic peripheral venous contrast studies of 23 patients with complex forms of univentricular heart were compared with cineangiocardiographic findings obtained in traditional and axial projections. The morphology of the main ventricular chamber (left type 16, right 6, indeterminate 1), of the rudimentary chamber (16 anterior and four posterior), the type and modalities of atrioventricular connections (common AV valve 6, two AV valves 13, absent left connection 4), the connections and the interrelationships of the great arteries as well as the degree of obstruction of the outlet portions were analysed by both methods. M-mode echocardiography did not provide valuable information about atrioventricular valve morphology: in three cases discordant results were found. Contrast studies improved the diagnostic capabilities and allowed identification of double inlet connection in 10 out of 11 patients and of single inlet in four out of five patients respectively.

Adolescent↗
PubMed1981

Analysis of atrioventricular junction, ventricular mass, and ventriculoarterial junction in 43 specimens with atrial isomerism.

We have analysed the atrioventricular junction, ventricular mass, and ventriculoarterial junction in 43 hearts with isomeric atrial chambers. Of the hearts, 32 had atrial chambers of bilateral right morphology while 11 had atrial chambers with bilateral left atrial characteristics. Among the hearts with right atrial isomerism, there were 13 biventricular hearts, all with ambiguous atrioventricular connection. Eight had a common valve and five had two atrioventricular valves. In the other 19 hearts, the atrial chambers were connected to only one ventricular chamber, 18 having double inlet ventricle through a common valve and the other having absence of the left atrioventricular connection. In these univentricular hearts, all possible types of ventricular morphology were found. The ventriculoarterial junction among these hearts with right isomerism showed great variation. In the hearts with left atrial isomerism, nine hearts had two ventricles and two were univentricular. The biventricular hearts all had ambiguous atrioventricular connection, six via a common valve and three via two valves. The two univentricular hearts both had double inlet via a common valve, one to a chamber of right ventricular type and the other to a chamber of left ventricular type. Both had rudimentary chambers of complementary pattern. The ventriculoarterial junction again showed much variation. Statistical analysis showed that pulmonary obstruction and a univentricular heart were both significantly more frequent in association with right compared with left isomerism. Significant differences were also noted in the two groups in terms of ventriculoarterial connections and infundibular morphology.

Aorta↗
PubMed1981

Atresia of left atrioventricular orifice. Anatomical investigation in 62 cases.

Sixty-two hearts without a patent exit from the left atrium to the ventricular mass have been studied. All had situs solitus and laevocardia. The material consisted of 32 cases with coexistent aortic atresia and 30 cases with patent aortic root. Five hearts with aortic atresia were biventricular with atrioventricular concordance and imperforate left atrioventricular valves, and 27 hearts were univentricular of right ventricular type, with absent left atrioventricular connection. The anatomy of this group was uniform, with extreme hypoplasia of all the left cardiac segments. Among the cases with patent aortic root, five were biventricular, with atrioventricular concordance and imperforate left atrioventricular valves, and 24 had absent left atrioventricular connection, 15 with univentricular heart of right ventricular type and nine with univentricular heart of left ventricular type. The final heart had double inlet univentricular of left ventricular type with an imperforate left atrioventricular valve. In this second group the aorta was larger in cases with discordant ventriculoarterial connection or in those with double outlet from the main ventricular chamber. A normal sized aorta without aortic arch obstruction was observed in nine instances. These are of great interest in terms of surgical anatomy since definitive palliation may be feasible.

Aorta↗
PubMed1981

[Study of left ventricular function in chronic volume overload (author's transl)].

Have been studied 51 patients with aortic incompetency (AI), 46 with mitral insufficiency (MI) and 31 with congestive cardiomyopathy (CM) as example of a primitive myocardial lesion. The mean parametres calculated were: the left ventricular end-diastolic pressure (LVEDP), the ventricular volumes, the ejection fraction (EF), the end-sistolic pressure-volume ratio (Emax) and the eccentricity. In the chronic volume overload, the relationship between the pump performance and the contractility (EF-Emax) is parabolic with an initial plateau (myocardial failure without circulatory failure); the EF-Emax relationship, in the CM, is linear without a plateau. The LVEDP is a limiting factor of the pump-contractility relationship in the AI: for the same value of the contractility, the pump function is greater depressed if the LVEDP is 25 mmHg (loss of the preload modulation); in the MI and CM the depression of the pump performance is a function only of the depressed contractility. The end-systolic eccentricity is correlated with Emax: the changes in the geometrical shape of the left ventricular chamber is due to the depressed contractility.

Aortic Valve Insufficiency↗
PubMed1981

[Atresia of the left atrioventricular orifice with "normal" aorta (author's transl)].

Though atresia of the left atrioventricular (av) orifice can show multiple types of ventricular morphology and different ventriculo-arterial (va) connections, clinical prognosis and surgical reliability depend upon the size of the aorta. Two cases with "normal" aorta are reported. The first was a female baby, died at four months, who had atresia of the left av orifice with right main ventricular chamber, va discordance and moderate pulmonary stenosis. The fatal outcome was due to progressive restriction of the foramen ovale. The second patient was studied at six months, is still alive, and showed atresia of the left av orifice with left main ventricular chamber, va discordance and pulmonary blood overload. According to this type of anatomy, modified Fontan procedure is postulated as possible and reliable surgical correction.

Angiocardiography↗
PubMed1981

Aortic atresia associated with the right atrial isomeric form of situs ambiguus.

A case is described which had the right isomeric form of situs ambiguus. A common atrial chamber was found with bilateral appendages of right morphology and bilateral superior venae cavae entered the chamber. It communicated through a common atrioventricular valve with a sole ventricular chamber of morphologically right ventricular type which gave rise anteriorly to the pulmonary trunk. There was aortic atresia, the coronary arteries and head and arm arteries being fed in retrograde fashion by a ductus arteriosus. It is emphasized that while aortic atresia is exceedingly rare in situs ambiguus of right isomeric type, it can exist. The case also exhibits the advantages to be gained from categorizing atrial situs on the basis of atrial morphology.

Abnormalities, Multiple↗