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Biomedical subjects

L Menicanti

Publications and source records attributed to L Menicanti.

At least 37 records · Page 2Linked to original sources
PubMed1992

Atresia of the left main coronary artery: clinical recognition and surgical treatment.

Atresia of the left main coronary artery is an extremely rare anomaly with very few cases presented in the literature. Even more uncommon are reports of successful surgical repair. This article concerns two cases of atresia of the left main coronary artery treated surgically with a favourable outcome. The two patients (a 16 year-old boy and a 43 year-old woman) had a different clinical presentation but identical angiographic and morphologic features. The authors examine the embryogenetic defect underlying this anomaly. The differential diagnosis involves two congenital malformations (single coronary artery and anomalous origin of the left coronary artery from the pulmonary trunk) and acquired atherosclerotic disease of the left main coronary artery; the distinguishing features of these conditions are reviewed. Surgical management by means of internal mammary artery revascularization is discussed in light of recent reports about adequacy of blood flow in internal mammary artery bypass grafts.

Adolescent↗
PubMed1992

Infundibular septal defect with severe aortic regurgitation: a new surgical approach.

Aortic regurgitation associated with prolapse of an aortic cusp and an infundibular septal defect is caused by the lack of anatomical support for the aortic annulus by the conal septum. This fact is taken into consideration in the new surgical approach that we performed in 5 children 3 to 16 years of age with infundibular ventricular septal defect and severe aortic regurgitation. The ventricular septal defect is closed by a patch anchored to another patch through the prolapsed cusp. This second patch is pulled up with the prolapsed cusp and is then fixed in the aortic wall. In all 5 patients, all clinical signs of aortic insufficiency disappeared, and only minimal aortic regurgitation could be demonstrated by color Doppler mapping.

Adolescent↗
PubMed1988

[Double mitral valve orifice associated with complete atrioventricular canal. Description of 2 cases].

The Authors describe two cases of double mitral valve orifice associated with complete atrioventricular canal. The first patient, 10 month-old male, affected by type A complete atrioventricular canal, underwent surgical repair which was performed in association with division of the tissue bridge between the two orifices. The patient died the day after because of severe mitral insufficiency and pulmonary oedema. The second patient, 3.5 year-old female, affected by type A complete atrioventricular canal with pulmonary banding, underwent a surgical procedure without division of the tissue bridge. In the postoperative period a suture dehiscence occurred which caused severe mitral regurgitation, and another intervention had to be performed; subsequently the patient did well and was discharged in good condition. The Authors discuss the possible role of two dimensional and Doppler echocardiography in the diagnosis of this uncommon condition; they also discuss the related surgical problems and stress the necessity to repair with a proper compromise between residual mitral insufficiency and a mitral stenosis.

Abnormalities, Multiple↗
PubMed1986

[Left ventricular fibroma in childhood: 2-dimensional echocardiographic diagnosis and surgical treatment. Description of a case].

We describe the case of a patient 4 months old transferred to our hospital for evaluation of occasionally detected cardiac alterations: ecg showed abnormal Q and negative T waves in D1 - aVL leads and chest x-ray was consistent with enlargement of the left ventricular cavity. After admission, 2D echocardiographic examination disclosed, in the left ventricular cavity, a large mass extending from the papillary muscles to the outflow tract. The mass was of uniform density and easily recognizable as a tumor. Although asymptomatic, the patient underwent operation 10 months later because of the risk of occurrence of severe conduction disturbances or arrhythmias. Histological examination demonstrated that the mass was a fibroma. At post-op echocardiographic and angiographic evaluation the left ventricle appeared abnormally dilated with a large aneurysm of the lateral wall and very poor pump function. Nevertheless the patient did well in the following months until a ventricular fibrillation occurred at home. He was immediately brought to hospital and resuscitation was attempted unsuccessfully. We discuss the role of 2D echocardiography in the diagnosis of cardiac tumors, the indication of the early surgical removal and the possible limitations of the technique we used in this case.

Echocardiography↗
PubMed1985

[Bidimensional echocardiographic diagnosis of the pulmonary valve agenesis syndrome in the newborn infant. Description of 2 cases].

We describe the cases of two neonates affected by the syndrome of pulmonary valve agenesis, in whom non-invasive diagnosis was possible by two dimensional echocardiography. The echocardiographic features we describe are the following: enlargement of the right ventricle in association with ventricular septal defect, malalignment type, dilatation of the right ventricular outflow tract, massive dilation of the main and branch pulmonary arteries, annular pulmonary stenosis. At the expected site of the pulmonary valve two ridges were seen, which did not have the typical motion of a fully developed valve. The ventricular septal motion was paradoxical in both cases. The diagnosis was confirmed at cardiac catheterization and the two neonates underwent operation unsuccessfully. The anatomic post-mortem examination confirmed the echocardiographic and angiographic findings. As successful treatment of this syndrome is difficult, we believe that a non-invasive echocardiographic diagnosis is very useful in order to avoid or, at least, delay a high risk cardiac catheterization.

Dilatation, Pathologic↗
PubMed1985

[Echocardiographic aspects of persistence of the right valve of the venous sinus].

The aim of this work is to demonstrate the possibility to identify persistent right sinus venous valve and to differentiate it from other right sided heart pathology by two dimensional echocardiography. We report the echocardiographic findings observed in three out of 215 paediatric patients we examined for clinically suspected congenital heart disease in 12 months period. The first patient was a 24 hours old newborn with transient pulmonary hypertension; the second one was a 6 months old child with pulmonary atresia, severe right ventricular hypertrophy, atrial septal defect and patent ductus arteriosus; the third patient, aged 6 months, had atrial septal defect and mild pulmonary stenosis. In all three patients a particular linear structure was seen, as a membrane that crossed the right atrium from the orifice of the inferior vena cava towards the atrial septum. This structure was identified as persistent right sinus venosus valve according to its morphology, its position into the right atrium and its connection to the atrial septum. The incidence of this echocardiographic finding was 1.4% in our series. In the first case contrast echocardiography from the inferior vena cava demonstrated the deviation of blood flow caused by the persistent sinus valve, although no intra-atrial pressure gradient was shown at cardiac catheterization. In the second patient who died during the operative procedure for making a systemic-pulmonary anastomosis, post mortem examination showed a membranous structure connecting the orifice of the inferior vena cava to the atrial septum.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiography↗
PubMed1980

[Myocardial protection during repair of congenital heart disease in infants (author's transl)].

The authors use the Bretschneider's cardioplegic solution at 4 degrees C as myocardial preservation in 45 open-heart cases in infants. Using moderate hypothermia at 28 degrees C, the mean myocardial temperature is 17.2 degrees C, using profound hypothermia at 18 degrees C, the mean myocardial temperature is 11.7 degrees C. The reinfusion criteria is myocardial temperature equal or up to perfusion temperature, that is about 40 to 50 minutes after the first infusion. The need of heart defibrillation has been 3 cases over 45 (6.5%). In the early post-operative course they notice 2 low cardiac output syndromes (5%) who responded well at catecholamines infusion. The hospital mortality is 2 deaths over 45 cases, unreliable with myocardial protection.

Child, Preschool↗
PubMed1978

[Clinical use of a minicomputer in heart surgery intensive care units].

The Authors present three respiratory parameters useful to estimate the respiratory and hemodynamic conditions of a cardiac patients before these turn into obvious pathological clinical pictures. The parameters are: alveolar-arterial oxygen difference, respiratory index and arterial-venous pulmonary shunts. The sophisticated mathematic calculations necessary to calculate and to elaborate such data are made, in few seconds, by a minicomputer which is very easy to work with. A clinical example in which the above-mentioned data have been employed helps to demonstrate their extreme usefulness.

Blood Gas Analysis↗
PubMed1977

[Congenital mitral valve malformations. Anatomical lesions and surgical treatment in paediatric age (author's transl)].

Congenital mitral valve malformations are diverse. When they present clinically in infancy medical treatment is often ineffective. Mitral valve replacement with prosthesis in children carries an high operative and postoperative risk. For these reasons the Authors have undertaken in 1972 a cooperative study which includes: 1) a surgical classification of the congenital mitral valve lesions; 2) a systematic attempt to repair the mitral valve. Over 43 observed cases, 18 have been operated upon. Eleven cases (61%) presented associated cardiac lesions. Hospital mortality was 16% (3 cases). There have been either mortality nor morbidity in the follow-up period. Eight cases have been recatheterized two years after the operation. The pulmonary artery pressure has significantly decreased and the mitral insufficiency disappeared almost completely. The classification, suggested by the Authors, is explained in details.

Angiocardiography↗
PubMedDate not supplied

[Current status of Senning's physiologic correction of transposition of the great vessels. Personal experience].

From January 1978 to December 1985, 70 children affected by TGA have been operated with the Senning operation. Among the 70 cases, 64 were simple TGA and 6 were TGA + VSD. The mean age at operation was 6 months (range 2 day - 3 years). Of 64 cases with simple TGA, two (respectively of 2 days and 40 days) died with an operative mortality rate of 3.1% of 6 cases with TGA and VSD, one died with a mortality rate of 16.6%. The total mortality was 4.2%. Since 1981 in a continuative series of 47 patients there were no deaths. Our current policy is now the following: after the diagnosis of simple TGA by ECHO, if the Rashkind septostomy is successful, we perform Senning operation over 3 months; if the Rashkind is unsuccessful, we give prostaglandin (PGE1) for a long period (25-30 days) and in case we do a Blalock-Hanlon septectomy. In conclusion we think that in our hands, the policy followed in the treatment of simple TGA is justified by the results achieved but this policy does not prevent us from using different techniques if the results are better.

Follow-Up Studies↗
PubMedDate not supplied

[Cardiosurgical intervention in extracorporeal circulation and intellectual performance in childhood. Study and follow-up of 20 cases].

6 and 12 months before and after surgery in E.C.C., twenty subjects, at the age of development between 6 and 14 years, suffering from congenital heart disease, were subjected to psychometric observations with tests of level and others (wisc, raven, pm 38, rey, bender), in order to analyse the intellective level, specific mental capacities and eventual modifications in the mental and cognitive performances of the patients. No psychometric, statistically meaningful variations were generally noticed during the 3 observations. No meaningful correlations resulted between the duration of E.C.C. and psychometric observations. The patients subjected to the E.C.C. longer than the average of the total group generally didn't show any statistically meaningful variations in the scores of the 3 observations. To sum up the authors think that the experimental group showed and maintained before and after the cardiac surgery, a normal developing and maturative level and anyway that after the follow-up, no changes in the several intellective capacities of the patient were noticed.

Adolescent↗
PubMedDate not supplied

[Deep hypothermia and cardiocirculatory arrest with the technic of central cooling in patients with simple transposition of the great arteries].

The deep hypothermia and cardiocirculatory arrest are employed mainly for two reasons; to reduce as much as possible the extra corporeal circulation time in patients more suitable to present the deleterious effects of the by-pass circulation, and to have surgical field completely free from the blood, making easier some surgical procedures. In the classic description of Hykasa the deep hypothermia necessary to have a safe cardiocirculatory arrest is obtained by means of surface cooling and an extracorporeal heat exchanger. In our experience deep hypothermia and cardiocirculatory arrest were achieved only by means of core cooling technique; 64 patients with TGA weighing less than 10 kg were operated upon by this method with a mortality rate of 3.1%. The most important mortality risk factors were associated to the low weight of the patients and to the age. The major criticism against core cooling is represented by the thought that this type of cooling can impair cerebral function. In 2 patients we had neurological complications but were unrelated to the technique. We conclude that, when is necessary to perform a cardiocirculatory arrest, the core cooling deep hypothermia is a good, simple and useful technique, with a low danger of neurological complications.

Extracorporeal Circulation↗
PubMedDate not supplied

[Trans-atrial correction of ventricular septal defects in infancy and childhood (author's transl)].

The Authors reviewed their surgical experience in correction of ventricular septal defects through tricuspid valve. 57 patients out of 59 operated for surgical closure of V.S.D. underwent this technique. All patients remained in sinus rhythm after surgical repair, 40% showed a right bundle block, and only in a case there was a right bundle block plus left anterior emiblock. Clinical conditions of all the patients greatly improved after intervention. Overall mortality in this series was 6.7%. The Authors conclude that trans-atrial approach is safe and advisable technique in surgical management of ventricular septal defects.

Bundle-Branch Block↗